reflections – Go Retire Psychiatrist

“Life is Beautiful”

We heard the song “Life is Beautiful” by Keb’ Mo’ last night on the Big Mo Blues Show. It was released 20 years ago. Big Mo said it helped him get through a difficult time. We think the song is beautiful and so do hundreds of other people on the YouTube video posted 16 years ago.

Keb’ Mo’ also did a very fine cover of Bill Withers’ song “Lean on Me” a few years ago in tribute to Withers who was his friend and mentor.

It’s not worth debating whether this song is classifiable as Blues—it doesn’t matter. I think it’s notable that of the many songs I heard on the KCCK Big Mo Blues Show last night, the list of the songs he posted early this morning after the broadcast was very short. He posted only a few, and we’re glad he listed this one.

Most would agree that “Life is Beautiful” is a fine example of contemporary acoustic blues. Compared to what we might usually hear in music labeled as the blues you might think it’s the opposite—almost “too happy” and soul-soothing to be the blues. Blues isn’t always about badness in life.

We Heard a Barred Owl Last Night

We both heard a barred owl last night. This was a line of thunderstorms rolled through the area. Sena thought it was in the front yard, but there are no trees out there and it’s more likely it was in the back yard.

I searched my photo files and couldn’t find one of a barred owl, although I remarked on seeing one about 11 years ago. It was on top of a street sign and I found an old blog post about it that I wrote about on the same day. I’ll repost it below.

I found a YouTube of a barred owl making typical calls. It might have been calling for a mate. Most articles will point out that this sounds like “Who cooks for you?”

I did a google search about barred owls. When a barred owl visits you, it could mean you’re in a transition in your life. About the time I saw it in 2015, I was a couple of years away from entering the phased retirement transition of my career as a consultation-liaison psychiatrist at University of Iowa Health Care.

I’ve been retired for six years now. I wonder why a barred owl would be visiting now?

Barred Owl Visit Post 2015:

So, the other day as my wife and I were out driving we saw this owl sitting on top of a street sign on the intersection not far from our house.

He looked straight at me. I remember thinking, “Where were you when the voles were gorging on our lawn?”

I’ve never seen an owl up that close, especially roosting on a street sign at a crossroads. Of course, it got me to musing on the crossroads in which we often find ourselves at different times in our careers and at pivotal moments in our lives.

There are big and little stages, the minor and major crossroads we navigate every day and at other transitions: childhood, adolescence, college, medical school, residency, graduation, marriage, divorce, and the birth of children, the death of parents, retirement, and our own approaching death.

Recently I got a funny and thought-provoking essay about this from a former resident who is now an attending herself staffing a psychiatry consultation service at a big university hospital in Cleveland. The title of Dr. Jeanne Lackamp’s perspective article is “The Stages of Consultation-Liaison Psychiatry.” In it she describes the stages, the crossroads if you will, of the psychiatric resident in a large general hospital from the perspective of an experienced teacher [1].

I was going to say she does it with the wisdom of a wise owl, but then I thought of the owl sitting on the street sign, whose wisdom I doubted. The owl’s eyesight is keen but there was nothing but concrete on the roads leading away from its perch.

There aren’t any voles out there.

Anyway, short excerpts (which I hope are considered fair use) from Dr. Lackamp’s stages are:

Anticipation: “As though hypomanic, you will eagerly accept the CL challenge….” This is it—Your Big Chance.”

Initiation: “Coping with patient death will become real…and will make you feel sad.” You will wonder how you can possibly do multiple months of this.”

Mastery: “Cockiness may backfire…errors still occur.” “…you feel confident that No One Else could have done better given the circumstances.” “This feeling lasts; until it does not.”

Anger: “Anger will manifest in several ways…” “…it will be tempting to start second-guessing your life choice of going into medicine in general, and Psychiatry in specific.” “Sleep will be rare now too…”

Acceptance: “…you will know what you are doing—but more importantly you will realize that what you know is not everything. “…you will know that you have endured something intense and were changed by it.”

I thought of this as I listened to one of our current senior residents talk about her approaching crossroads. She’ll be a consulting psychiatrist at a private hospital.

She’s excited about it and also wanted to know that her old teacher (which is me, the wise old owl) will be available for collaboration if she needs it.

I suddenly have this craving for voles.

Reference:

Lackamp, J. M. (2015). “The stages of consultation-liaison psychiatry.” Acad Psychiatry 39(2): 217-219.

Thoughts on House Finches

This morning, I got a snapshot of a male house finch sitting on the back porch fence post. He’s a proud looking fellow. I saw the female a minute earlier but could not catch a picture of her.

It’s spring; they’re probably a mating pair and we saw them last year. So, there will soon be eggs somewhere out in the woods past our back yard. There will probably be chicks soon.

Maybe the chicks will survive. I remember during the month of May in 2019, I was keeping watch on a nest of house finches just outside of my office window. I would go out every day to a skinny little juniper tree, part the branches, and snap pictures of the eggs and later, the squirming hatchlings.

One day, I heard a noise like the flapping of big sheets outside my window. When I finally looked out, I saw the biggest crow I’d ever seen, just taking off with all of the nestlings clenched in its beak.

The mother house finch arrived minutes later and searched frantically for her chicks for over half an hour.

It wasn’t until then that I learned I was at fault for exposing the hiding place of the nest in the tree. I went there daily and spread the branches, probably while the crow watched me from high above in the sky.

I thought I learned my lesson, but I didn’t. In May of 2024, a mating pair of house finches built a nest in our artificial Christmas tree right on our front porch, a step away from the front door. The ruddy male would feed the female, who had laid 4 eggs.

I set up a critter cam on a tripod and filmed them for days. Every time I hustled out there to get the camera to download the videos, I scared the birds off. We watched for 17 days. The typical time to hatching is about 14 days. I finally tossed the whole thing out in the back yard.

There are a red tail hawks, turkey vultures, and crows all over the sky. I hope the house finches know better than to build a nest in any of the big pots on our porch. I know better than to draw attention to them now.

Do We Really Need Artificial Intelligence to Help People Who Are Demoralized?

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

Treating Demoralization

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

Coherence Versus Confusion

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

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

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

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

Communion Versus Isolation

1. Who really understands your situation?

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

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

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

Hope Versus Despair

1. From what sources do you draw hope?

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

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

Purpose Versus Meaninglessness

1. What keeps you going on difficult days?

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

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

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

Agency Versus Helplessness

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

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

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

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

Courage Versus Cowardice

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

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

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

Gratitude Versus Resentment

1. For what are you most deeply grateful?

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

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

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

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

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

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

References:

James L. Griffith, Lynne Gaby,

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

Psychosomatics,

Volume 46, Issue 2,

2005,

Pages 109-116,

ISSN 0033-3182,

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

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

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

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

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

Journal of the Academy of Consultation-Liaison Psychiatry,

Volume 67, Issue 1,

2026,

Pages 71-78,

ISSN 2667-2960,

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

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

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

Svengoolie Sven Squad Movie: “The Mist”

Last night the Sven Squad presented the movie, “The Mist” on the Svengoolie show. This one is hard to simply poke fun at. It’s also hard to compare to Stephen King’s novella of the same name published in 1980 because I’ve never read it.

The graphic violence throughout the film and the ending left me cold. I think even the Sven Squad had a difficult time making jokes in between scenes.

That said, the story and characters reminded me of certain kinds of people and certain themes. One kind of person is the cult leader. In the film this would be Mrs. Carmody (Marcia Gay Harden). She was this hyper religious person who acted crazy, yet managed to convince a large number of people that she was the savior who could deliver everyone in the grocery store from the horrible fate lurking in the mist. This turns out to be human sacrifice, which is what some ancient cultures did to appease the gods and also gave them a sense of control over nature.

For some strange reason, she was not eaten by one of the monsters, despite the fact it landed on her chest, climbed up on her neck and sprinkled salt, pepper, and oregano on her face.

It also reminds me of cult leaders who managed to persuade many people to commit suicide, e.g., Jim Jones (Peoples Temple) in the 1970s, Marshall Applewhite (Heaven’s Gate) and David Koresh (Branch Davidians) in the 1990s.

I wasn’t sad about Mrs. Carmody’s fate.

One theme I think of from this movie is hubris. Sure, it’s something that will trigger bad memories for some people of their undergraduate college days, but I think it explains why the military decided they could safely open a portal between dimensions. Hubris is overweening pride and means you’re tempting the gods to destroy you when you think you can get away with sticking your chewing gum under your seat at the movies. People think they can control whatever monsters they find in the universe and can stuff trouble back in Pandora’s box.

Another common idea nowadays is that some otherwise unexplainable creatures you almost never see in real life and never find fossils for (like Bigfoot) might be because they are interdimensional beings. Hey, that works for some people.

So, you can go ahead and keep looking for wormholes and portals that open up the gates of hell and there you go. You just let a mosquito the size of an SUV in the house. Are there doorknobs on portals? Did you listen to your mother when she told you to shut the screen door behind you?

No, and you know who you are.

I got a kick out of Ollie Weeks (Toby Jones) who could shoot a monster by turning his back on it and using a mirror and firing backwards over his shoulder, blasting it into next week. How many bullets did that gun have? I thought it was ten but it seemed like there were more, even though it misfired once. Ollie was a hero without hubris.

I didn’t get the ending and I’m not going to put in a spoiler on it. But it’s another place where the number of bullets in the gun gets to be the focus of some reviewers who have horrible suggestions.

This movie is tough to rate because it takes itself too seriously. The acting was riveting in some scenes and just overdone in others, in my opinion. It’s not for kids, yet there was a little kid who played a big role in it. The ending seems to lend itself mainly to instructions on how to commit homicide and suicide. The cavalry arrives too late. It’s packed with action but it lacks heroes to admire, except for self-effacing, deadeye Ollie.

I’m giving this movie a Shrilling Chicken Rating of 3/5.

Iowa Legislature Bills I Could Live Without

I should stop reading the news. I’ve just found a couple of other Iowa Legislature bills that are anti-vaccine.

One of them is the HF 2287 I mentioned yesterday that would make vaccine manufacturers steer clear of Iowa altogether.

Another two I just discovered today:

HF 2171: This one which seeks to make vaccines for school age children voluntary. No child in elementary or secondary school in Iowa would have to be vaccinated against diphtheria, pertussis, tetanus, poliomyelitis, rubeola, rubella, and varicella. This is not safe for anyone.

SF 2095: This one seeks to exempt students from vaccines in medical, nursing, or other health care-related degree programs.

There’s a news article about SF 2095 which makes it clear what it is about. I don’t understand why a person studying medicine or any other health care-related degree program would not need to get vaccinated against communicable diseases. This bill would require private schools to provide some other alternative training program instead of those that require vaccinations. If they don’t, they’d be penalized, either by losing access to the Iowa Tuition Grant Program—or getting fined. None of that makes sense to me. If you’re in training to be a doctor, you should get vaccinated. If you don’t understand why vaccinations are vital to practicing medicine, you shouldn’t be in medicine.

If I sound like a curmudgeon about all this, so be it. I’m a retired doctor and I graduated from the University of Iowa College of Medicine in 1992. I spent my career practicing consultation-liaison psychiatry, so I was always at the interface between medicine and psychiatry. It was always a challenge for me to balance the art and science of medicine. And I didn’t always do it very well.

But I’m puzzled by what looks like an awkward imbalance in the view of medicine today. I’m a little cranky about it, and I like to think my age entitles me to react that way sometimes. I could add a quote from William Osler here, but I’m more prone to jokes as a I get older, probably because I know I’m no wiser than anyone else.

Did you hear Chuck Norris got the Covid vaccine? The vaccine is now immune to everything.

A Funny Thing Happened on the Way to the Pentagon

So, just for laughs I sometimes watch Ancient Aliens (you know, the UFO show with the hair dude). Last night, they were talking about some guy named Valiant Thor as if he were a real person. Maybe some of you know about the book, “Stranger at the Pentagon,” which you can read for free on the Internet Archive. I just quickly clicked through the pdf of it and it’s pretty interesting. The one I saw had sections about Men in Black (MIB) in it, which of course means Will Smith and Tommy Lee Jones are even older than we think.

It was written in 1967 by Dr. Frank E. Stranges and it’s supposedly a story of an extraterrestrial named Valiant Thor who presented to the White House in the 1950s and spoke to President Eisenhower and others, giving the urgent message that Earthlings need to shape up or the planet would be destroyed.

OK, the spoiler is that there’s no evidence this ever happened, although many people, like Fox Mulder, want to believe.

I want to believe, too but there’s no official record Vai (as Valiant Thor is sometimes called in the book) ever lived at the White House, although maybe he snorted something you can sometimes find in the White House but nobody officially will admit that ever happens either.

One person stated that the idea for the book might have come from the 1951 film “The Day the Earth Stood Still.” Artificial Intelligence (who always butts in to my web searches) doubted it’s ever been on the Svengoolie TV show, but I found a Facebook post from 2025 which called it a “Sven fan favorite.” It’s probably never been on Svengoolie because it’s far too classy. There’s an interesting article about it on Turner Classic Movies but I don’t know if TCM ever showed it.

As near as I can tell from just from what I’ve read on the web about this movie is that it was made in the early Cold War days and it’s really sending a message to mankind warning them away from killing everybody and the planet and instead strive to establish peace in the world. It’s long been regarded as a cinema masterpiece.

Did it influence Dr. Stranges to write the book “Stranger at the Pentagon”? I don’t know, but some people think so, judging from one social media comment. I think that person might have been put off by the attempt to make it sound like it was historically accurate, which is what many people seem to think.

In my opinion, the whole yarn about Valiant Thor is fiction that, while not historically accurate, is compelling enough to make you think about how important it is for national leaders and people who live on the planet to try and clean up our act. Efforts to make this story seem like it actually happened backfires and misses the point.

By the way, none of this has anything to do with Bigfoot.

One Anecdote from Dr. Martin Luther King, Jr is Nothing to Sneeze At

I’ve finished reading both biographies of Dr. Martin Luther King, Jr. (the one by Jonathan Eig and the autobiography edited by Clayborne Carson).

Both books were fascinating. Many of the accounts of King’s life were familiar to me mainly because I had seen them written about in other books and articles. Some of them are a strange mixture of pathos, terror, and even a little humor if you can imagine it. For me, one of the most touching anecdotes was the one about the white girl who wrote a short letter to King after he was stabbed by a demented black woman on September 20, 1958. It was in both biographies.

He was at an event in which he was autographing one of his books. A black women pushed through the crowd and asked him if he were Martin Luther King. He didn’t look up and said simply, “Yes.” The woman stabbed him with a letter opener. The blade stopped very close to his aorta and the doctor who treated him said he could have exsanguinated if he had just sneezed.

Dr. King got a lot of kind letters from people about that, but the one that is most memorable to him (and me) was from a 9^th grade high school student who wrote that she was a white girl and said “I am so happy that you didn’t sneeze.”

Later, King would use the phrase several times in his final speech (“I’ve Been to the Mountaintop”) which he delivered at the Bishop Charles J. Mason Temple in Memphis before he was assassinated at the Lorraine Motel there in April of 1968.

Both of the biographies are riveting documents of the life of a preacher devoted to the principle of non-violence. We can still learn from him.

Thoughts on the Book: “King: A Life” by Jonathan Eig

I just finished Jonathan Eig’s biography of Dr. Martin Luther King, Jr and I have just a few thoughts to share on my immediate impression of the book. Before I read the book, I got the impression that there might be a detailed description of Dr. King’s mental health.

Although I didn’t see any specific speculation by Eig on the matter, he did mention psychiatrist Dr. Nassir Ghaemi’s impressions about King based on historical records that Dr. King had suffered from a clinically significant mood disorder. Eig wrote a one sentence summary which followed a comment by King’s wife Coretta about his depression:

“Decades later, the psychiatrist Nassir Ghaemi would write that King probably suffered severe depression, a psychiatric illness that can enhance “realism in the assessment of one’s circumstances as well as empathy toward others.”

This was followed by a comment from a psychologist who cast doubt on the idea that King suffered from depression.

I’ve never read any of Dr. Ghaemi’s books. Eig didn’t list any specific books by Dr. Ghaemi. I think the relevant source might be his book, “A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness” published in 2011.

In a previous post I expressed my skepticism that the suicide attempts sometimes mentioned (although not consistently called that in Eig’s book). The only two such episodes described in his book are reactions to his grandmother being injured in the first instance and after she died in the second. He jumped out of a second story window both times and escaped serious injury. He was 12 and 13 years old respectively. Neither account describes any formal outpatient or inpatient mental health evaluation or treatment. It sounds like these were impulsive reactions based on the descriptions. I didn’t find any accounts in the book of suicide attempts in his adult life.

The Goldwater Rule which has been in the American Psychiatric Association (APA) Principles of Medical Ethics since 1972 discourages clinicians from diagnosing psychiatric illness in currently living persons. While that may not necessarily apply to deceased persons and may or may not only be relevant to members of the APA, I’m still unsure whether it’s always appropriate for mental health professionals to publicly entertain speculations or inferences about psychiatric diagnoses in anyone without an in-person evaluation. One possible exception might be for a threat assessment.

All that said, I didn’t find anything in Eig’s book that would contradict a non-psychiatric explanation for Dr. King’s emotional states in the context of the extraordinary pressures and burdens in his life. Although at times he was hospitalized for fatigue and “depression” it’s difficult to tell exactly how often.

This blog post so far takes up a fair amount of space discussing Eig’s book regarding the emotional side of Dr. King. There’s a lot more space in the book that emphasizes his incredible accomplishments, despite his being up against terribly high odds.

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”

Theodore Roosevelt

Still Reading Dr. MLK Jr Biographies

I’m just checking in to let you know I’m still reading Jonathan Eig’s biography of Dr. Martin Luther King Jr. I’m in the last section. I plan to read The Autobiography of MLK Jr., edited by Clayborne Carson next.

I’m not ready to share much right now in the way of my impressions other than to say that it’s at least as painful to read from an emotional standpoint as the other books by great authors I’ve read and which have prompted visits by invitation to The University of Iowa College of Medicine in the past to present the MLK Jr Distinguished Lectures:

“Our Hidden Conversations: What Americans Really Think About Race and Identity” by Michele Norris.

“Caste: The Origins of Our Discontents” by Isabel Wilkerson (who also wrote “The Warmth of Other Suns: The Epic Story of America’s Great Migration,” which won the Pulitzer Prize).