reflections – Go Retire Psychiatrist

Connections Between Psychiatry, Artificiality and Blues Music?

I heard a song on the KCCK Big Mo Blues Show that I first heard in June of 2025. The song is “Artificial” by Walter Trout.

At first blush, I agree with what I think is the point of the song, which is basically a protest against artificiality which could manifest in a range of ways from superficiality and dishonesty in communications, attitudes, style of clothing, relationships, and all the way to Artificial Intelligence (AI).

The other connection I make is to the artist himself. Walter Trout developed Hepatitis C (eventually leading to liver transplant) according to a Wikipedia article which connected his lifestyle to contracting the disease. In my role as a consultation-liaison psychiatrist, I saw many patients with Hepatitis C who were referred to psychiatry from gastroenterology.

I was the main psychiatrist who evaluated them for treatment with Interferon-alpha. At the time it was the only treatment for Hepatitis C and was frequently associated with many side effects including depression. I was also one of the psychiatrists consulted as part of liver transplant evaluations.

Trout got very sick from Hepatitis C and made a remarkable (even miraculous) recovery after his liver transplant. Interferon is no longer used to treat Hepatitis C. It has been replaced by direct-acting antiviral (DAA) agents. They’re much better-tolerated and more effective.

The other aspect relevant to Trout’s song is ironic. The newest scientific literature supports the idea that AI can be helpful for diagnosing Hepatitis C, predicting its progression and response to treatment.

That doesn’t mean I’m completely sold on AI.

Aside from that, there’s interesting research suggesting that there may be a link between schizophrenia and bipolar disorder and Hepatitis C infection (which could be hiding deep in the brain’s choroid plexus lining the cerebral ventricles). In other words, some people might have mental illness because of the liver disease itself.

If you think about the dictionary definition of the word “artificial,” you can hardly dismiss this kind of research as insincere.

Glue Myself to My Biography

There’s a reason for why I so often tell Dad jokes. In keeping with my post from yesterday about Dr. Martin Luther King, Jr’s biographies:

I glued myself to my autobiography. You may not believe it, but that’s my story and I’m sticking to it.

We’ve ordered a couple of biographies about Dr. King. One of them is his autobiography and the other is Jonathan Eig’s book, “King: A Life.”

I’m getting to be too old to write my own autobiography—guess it’ll have to be done by autopen. Sorry about that one (no I’m not).

I’m a psychiatrist so I know when I’m using humor as a defense mechanism. A lot of good that does.

I’ve never seriously considered writing my autobiography. I could have it tattooed on my back—it would be my backstory.

Seriously—no, I guess that’s impossible. On the other hand, every year about MLK Day, I think about the blog I wrote that the Iowa City Press Citizen published in 2015 on January 19th. It’s becoming almost something like a tradition. I think I need to repost it annually around this time. The title is “Remembering our calling: MLK Day 2015.”

“Faith is taking the first step, even when you don’t see the whole staircase.”

-Martin Luther King, Jr.

That quote is interesting because Jonathan Eig’s biography of MLK can be said to reveal more of the staircase, so to speak, at least from the standpoint of his flaws as well as his strengths. But I stray from the tradition:

As the 2015 Martin Luther King Jr. Day approached, I wondered: What’s the best way for the average person to contribute to lifting this nation to a higher destiny? What’s my role and how do I respond to that call?

I find myself reflecting more about my role as a teacher to our residents and medical students. I wonder every day how I can improve as a role model and, at the same time, let trainees practice both what I preach and listen to their own inner calling. After all, they are the next generation of doctors.

But for now, they are under my tutelage. What do I hope for them?

I hope medicine doesn’t destroy itself with empty and dishonest calls for “competence” and “quality,” when excellence is called for.

I hope that when they are on call, they’ll mindfully acknowledge their fatigue and frustration…and sit down when they go and listen to the patient.

I hope they listen inwardly as well, and learn to know the difference between a call for action, and a cautionary whisper to wait and see.

I hope they won’t be paralyzed by doubt when their patients are not able to speak for themselves, and that they’ll call the families who have a stake in whatever doctors do for their loved ones.

And most of all I hope leaders in medicine and psychiatry remember that we chose medicine because we thought it was a calling. Let’s try to keep it that way.

You know, I’m on call at the hospital today and I tried to give my trainees the day off. They came in anyway.

I used to joke that they would erect a playdoh statue of me in the Quad (Quadrangle Hall was there) on the University of Iowa campus someday. Unfortunately, the Quad was demolished in 2016, so I guess I can’t put that in my autobiography.

Since I retired in 2020, I keep meaning to write my memoirs, but I never get around to it. I guess that makes it my oughta biography.

Kudos to Dr. George Dawson on Today’s Blog Post!

I want to give a shout-out to Dr. George Dawson on his post today, “Enthusiasm is a plus…” It’s right on the mark.

Having a zest for medicine is the reason why many physicians undertook the rigorous training in medical school, residency, and beyond. A sense of humor is evident in George’s essay—and he doesn’t need to be comedian.

His essay reminded me of the many trainees who took their rotation through the psychiatry consultation service when I was running it (or tried to, anyway!). Many deserve a shout out as well for not only working hard on the service but teaching as well. I prevailed on them to make a short presentation during the rotation. I called it the Dirty Dozen.

They picked a topic often about an interesting consultation case we had seen and put together a talk with a dozen slides. They gave a Dirty Dozen called: “Neurology and Psychiatry: Divided or United?” It included some of Dr. Ron Pies ideas on a subtopic of whether psychiatry and neurology can ever be combined as a discipline (three diagrams of his are in the slides). You can also see a sense of humor, especially in the first slide.

Note: Because I couldn’t locate all of the trainees to get their permission to leave their names on the title slide, I chose to identify them as “Trainees.” I’m still very proud of all of them.

Slides from trainees on Neurology and Psychiatry: Divided or United? from UIHC Psychiatry Consultation Service, 2017. Figures included from Dr. Pies’ article in Psychiatric Times (see below):

Citations:

Arzy, S. Danziger, S. (2014).. “The Science of Neuropsychiatry: Past, Present, and Future.” The Journal of neuropsychiatry and clinical neurosciences 26.4 2014): 392-395.

Daly, R. Pies, R. (2010). Should Psychiatry and Neurology Merge as a Single Discipline? Psychiatric Times.

Fitzgerald, M. (2015). Do psychiatry and neurology need a close partnership or a merger? BJPsych Bulletin, 39(3), 105–107.

Pies, R. (2005). Why psychiatry and neurology cannot simply merge. J Neuropsychiatry Clin Neurosci; 17: 304-309.

Schildkrout, B., Frankel, M. (2016). Neuropsychiatry: Toward Solving the Mysteries That Animate Psychiatry. Psychiatric Times.

Price, BH., Adams RD., Coyle, JT. (2000). Neurology and psychiatry, closing the great divide. Neurology January 11, 2000 vol. 54 no. 18

Ronald W. Pies, M., & Robert Daly, M. (2026, January 5). Should psychiatry and neurology merge as a single discipline?. Psychiatric Times. https://www.psychiatrictimes.com/view/should-psychiatry-and-neurology-merge-single-discipline?

Shoveling Through Retirement Thoughts

I was just musing on Philip Rivers. You know about him. I blogged recently about his coming out of retirement to play quarterback for the Indianapolis Colts. I guess you already know this, but he retired again.

Unlike Philip Rivers, I’ve not even considered coming out of retirement since I left my position at The University of Iowa Health Care (UIHC) over 5 years ago. I never looked back.

But that doesn’t mean I never think about looking back. I look back a lot and that’s mostly because I’m an old guy. I was a consulting psychiatrist in the general hospital.

Anyway, occasionally I search my name on the web and laugh at what comes up. I never went to Baylor College of Medicine, much less graduated from there.

I did a few things when I was a doctor. Not all of them were about work, but most of them were.

Those who know me know that I always hated Maintenance of Certification (MOC). I checked the American Board of Psychiatry & Neurology website and my MOC contribution to continuing education is still there. It’s a clinical module on Delirium, which a lot of doctors and other health care practitioners see every day in the hospital. Dr. Emily Morse worked on it as well. She’s still working at UIHC.

I co-edited a book about consultation-liaison psychiatry with my former chair of the Psychiatry Dept, Dr. Robert G. Robinson, may he rest in peace. It’s “Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry.” You can buy it on Amazon—please.

I wrote a case report on catatonia caused by withdrawal from lorazepam (a benzodiazepine), and it’s still available. It was first published in Annals of Psychiatry.

But one of the things I’m proudest of doing was writing a short article for the University of Iowa Library for Open Access Week.

In it, I tell a short anecdote about my lofty (OK, a better word is “greedy”) thoughts about how much money I could make shoveling snow. I was just a kid and I never made it outside to shovel anybody’s walk because I was too busy calculating my income. I wrote that way back when I had another blog, The Practical Psychosomaticist. The photo of me shows my Leonard Tow Humanism in Medicine pin fixed to my lapel—another thing I’m proud of. By the way “Tow” rhymes with “Wow.”

Libraries have always been my one of my favorite places to hang out. Anyway, I’ve got more time to do things like hang out in general. I think Philip Rivers will adjust.

Sunrise A Little Before 2026

We saw a really pretty sunrise this morning. Sunrises always make feel expectant, hopeful, and a little excited. It reminded me of that show “Sunrise Earth,” anyone remember those? They didn’t even have music, just the sounds of nature and the scene of dawn slowly giving its own introduction.

Svengoolie Movie: “The Creation of the Humanoids”

Svengoolie Intro: “Calling all stations! Clear the air lanes! Clear all air lanes for the big broadcast!”

Last night, I watched the Svengoolie movie, “The Creation of the Humanoids,” and I don’t mind telling you, I was reminded of Isaac Asimov’s book, “I, Robot.” Believe it or not, I purposedly avoided reading any other reviews of this movie to see if they mention the possible connection of Asimov’s book with this movie. It preceded the film by 12 years, and it’s at least conceivable that producers and writers might have been inspired by the plot, took the idea of the robot laws from the book and dressed it up in at least some of the dialogue. I think there’s also a connection to Artificial Intelligence (AI) in our own time.

The last two stories in Asimov’s book are “Evidence” and “The Evitable Conflict,” both of which seem to be exemplified in “The Creation of the Humanoids.” They’re both about the conflict between robots and humans and how difficult it is to apply the Laws of Robotics, the first of which is that “a robot not injure a human being or, through inaction, allow a human being to come to harm.”

The robots in the film actually create the humanoids with the overall goal of saving the human race from extinction. And they’re programmed to obey the “Prime Law” which prevents them from killing humans. The psychological conflict of Captain Kenneth Cragis (Don Megowan) and Maxine Megan (Erica Elliot) and the rationale the robots supply for what they did both to and for humans echo the Laws of Robotics.

In the movie, the politics of the racist conflict between the robots and the group calling themselves the members of the Order of Flesh and Blood remind me of the Civil War—right down to the uniforms of the latter and their slur for the robots, which is “Clickers” (substitute another two-syllable slur and you get the idea).

In Asimov’s story “The Evitable Conflict,” something called the Machine takes control of a variety of factors manipulating natural resources, goods, services, and even the social fabric on the planet to protect humans, who have a penchant for overusing and destroying resources and each other. The robots in “The Creation of the Humanoids” do something similar and break the fourth wall to tell you about it.

Anyway, Captain Kenneth Cragis is a member of the Order of Flesh and Blood and reminds me of a character in the 2004 movie “I, Robot,” which is Sonny. An important part of Cragis is hidden from the audience as well as himself.

The dialogue is heavily intellectualized and the robots, which are supposed to be blue, wind up showing up in different colors and those eyes! Cragis and his sister, Esme Cragis Milos (Frances McCann) have a protracted and almost poetic discussion about their differences of opinion about the robots. I wonder if McCann’s revealing dress was intended to distract the audience from the dry declamations.

The scene in which Cragis confronts the robot Pax who has somehow chosen Esme to be his main squeeze is puzzling. Cragis sort of breaks Pax (David Cross) and converts him into a ’57 Chevy, which barely upsets Esme. The scene in which Dr. Raven (Don Doolittle), a robotic scientist, makes some adjustments on a disembodied arm is one example of many which proves why even Svengoolie calls this movie “a low budget” production. The furniture pieces look like they’re made for children; both Cragis and Esme might as well have sat on the floor.

Ok, so this sounds more like a review than my usual fibs and jokes, but I think it’s because the movie reminds me of something that is on a grander scale. Speaking of scales, except for the low production value, I thought movie was pretty good and I would give it a 4/5 Shrilling Chicken Rating. Sena, who watched it this morning, thought it was really good and would give it a 5/5 rating despite “the glassy eyeballs.” So, I’ll give it a 4.5/5.

Re-introducing The Good Enough Psychiatrist, Dr. Jenna Cheng

Sena just found a blogger psychiatrist who wrote the blog “The Good Enough Psychiatrist,” and her former blog link is still on my blog site. Dr. Jenna Cheng has a new blog and podcast, and it’s called “Attached and Enlivened Psychiatry.” The link is on the menu.

The featured image for this post is the Kintsugi pottery picture, which I first learned about from her blog and later blathered about back in September this year some more, relating to my link between it and blues music. She actually hit the like button on it.

When you get a chance, by all means check out the podcast that Dr. Cheng and Dr. Patrick Kelly run. “It’s called Good Enough Shrink, which rings a bell. I listened to “Münchausen and Münchausen by Proxy: Harming Self and Others to Play the Sick Role.” They did a great job!

Special Mention on Dr. George Dawson’s Post Today

I just want to send a link to Dr. George Dawson’s post The Phenomenological Suicide Assessment – The Legacy of Dr. H. It’s a great Christmas gift to teachers and learners everywhere. Happy holidays to George and everyone else.

Thoughts on Comebacks

I watched the first half of the Colts vs 49ers game last night and I thought Philip Rivers didn’t look half bad for a 44-year-old guy who’s been out of the game for five years. Did you know he has 10 kids? OK, now that I’ve got that out of my system and that would be, what—the 44^th time you’ve heard that since he took the field?

So what the Colts lost? His big family was up in the stands going crazy, cheering him on.

I read an article this morning which had Steve Young saying he could make a comeback at his age—which is 64. I couldn’t believe it. The same story mentions that George Blanda played for the Oakland Raiders when he was 48 back in 1975.

It got me wondering whether I could make a comeback as a general hospital consulting psychiatrist. Could I gallop up 6-8 floors of University of Iowa Health Care? You bet your bottom dollar—I couldn’t.

It’s hard to retire. Every once in a while, I miss hiking up and down the hospital with my camp stool, deftly swinging it around and sitting with the patients and families, telling medical students and residents all kinds of lies (I mean “wise old adages and pearls of clinical wisdom”).

I get a kick out of just wondering what it would be like. I get a vision of myself with a big, golden glowing aura of greatness around my head—until I come to my senses. Hey, nobody’s going to pay me a quarter million dollars to run the consult service for the few months I’d be able to limp around the hospital, falling off my camp stool when my legs go numb or the chair breaks.

It’s not like I can just throw a football like it’s nothing after 5 years. I’d have to prove I still have enough clinical smarts to figure out how to introduce myself (Hi! I’m Philip Rivers and you need to go long!”).

The Maintenance of Certification Circus is still a thing and it’s worse. I’m not saying doctors don’t undertake the arduous task of essentially retraining to be what they once were—because that’s not good enough anymore.

Last night, the camera caught Phil more than once being just as hard on himself as he was with other members of the team who weren’t in the right spot at the right time. Most physicians are perfectionists and if you’ve been out of the game for a while and you try to squeeze back in, you could wind up mumbling to yourself, “They don’t make footballs like they used to!”

I didn’t stay up for the second half of football game. It wasn’t because of anything Philip did or didn’t do on the field.

I just can’t stay up that late nowadays.

Profound Thoughts on Topological Brain Changes

I ran across this article in the news about topological changes that happen in our brains as we age. You can try to read the original open access paper published by the author Alexa Mousley.

The topological changes in the brain that occur in the brain are linked to the structural connections that are made or not in human development and roughly correspond to the main epochs of brain structure in our lives: childhood (transition to adolescence around 9 years old), adolescence lasts until around 32 years old when we finally reach adulthood, then at age 66 we reach the early ageing stage and that finally changes into late ageing or old farthood around age 83. It’s a good thing I retired 5 years ago.

What this says, of course, is that nobody should be getting married or driving until they hit age 32. There are buses, you know, although we do have self-driving cars which explode on impact so thank goodness we don’t need to worry about that.

Also, it implies that you shouldn’t be drafted into military service until you’re presumably old enough to know that war doesn’t solve any problems.

Furthermore, this could lead to earlier retirements, reducing the need for awkward discussions with tenured professors who are apparently unaware they often arrive at the office with their pants on backwards. Just boot them out the door!

Why didn’t we think of this topology thing a long time ago?

For an interesting topology discussion, see the Wikipedia article, which has an interesting photo of something called homeomorphic topology, an amusing example of which is the picture of continuous transformation of a coffee mug into a donut, or as many Iowa City people would prefer, a bagel (something that looks like a doughnut but is so tasteless you have to slather it with a pound of cream cheese).

If you have any questions, call the author of the study. You’re welcome!

Mousley, A., Bethlehem, R.A.I., Yeh, FC. et al. Topological turning points across the human lifespan. Nat Commun 16, 10055 (2025). https://doi.org/10.1038/s41467-025-65974-8