TV with Heart

The other night I watched a show I’ve seen 3 times and it still makes me want to cry. It’s the Heavy Rescue 401 episode with Bear the heavy wrecker operator with the Ross company who lets an 8-year-old boy diagnosed with cancer hold the steering wheel and pull the horn as they take a drive around the farm where the family lives.

They hug and it’s tough to tell whether Bear is comforting the boy or the other way around. I guess it’s both.

I saw a Facebook page about the boy, who succumbed to cancer a few years ago. People are still leaving warm messages.

I watch a fair amount of TV and I make fun of most of it, including the paranormals. They’re pretty formulaic, re-investigating decades old cases that never get solved about alien visitors in spaceships, leaving behind evidence that goes missing from government storage warehouses. Because it gets lost, nobody has to explain why there is a notable lack of any convincing evidence for what most UFOs are and who might be flying them.

I can’t generate much emotion for the paranormals. I mostly laugh at them. How can you lose or throw out physical evidence of UFOs and aliens so many times?

“We need to make more room in here; can we toss something in the trash compactor?”

“Sure, get rid of those photos of military personnel taking selfies with aliens driving UFOs and drinking beer. That’ll make room for the 400-page binders of the syllabus for the graduate school course ‘Effect of Chimpanzee Eyebrow Dandruff on Prime Interest Rates During the 20th Century.’”

One of paranormal shows did an extensive review of the Kecksburg, Pennsylvania UFO, the one shaped like a macadamia. No wait, it was shaped like an acorn. It was dark and brooding, full of intrigue, veiled threats, and an alien pilot. As usual, evidence was lost.

Did you know Kecksburg throws an annual UFO-themed party? They just had the 17th Kecksburg UFO Festival just last month, replete with something called a burnout contest, fireworks, and crafts. The people of Kecksburg aren’t letting the government conspiracy get them down. They’re more than happy to let the paranormal producers visit because it gives the town leaders a chance to draw more tourists to the area.

I get a kick out of Men in Black (MIB) too, and I won’t tell you how many times I’ve seen the first one and the first two sequels. In Men in Black, Agent K shows the new recruit, Agent J, a special universal translator and says MIB is not even supposed to have it and says, “I’ll tell you why. Human thought is so primitive it’s looked upon as an infectious disease in some of the better galaxies.”

That’s why it helps to watch some other TV shows, the ones with heart where real people who are not acting but living do the mundane things which are seldom the most treasured of miracles. They remind you of the better human qualities like humor, kindness, love, generosity, gratitude, and the experience of sorrow that can sometimes humble a species which often suffers from overweening pride.

It can sometimes make you cry.

The Mundanity of Some Yellow Things

We went out for a walk on Scott Boulevard and saw a lot of yellow things. We were looking for Goldfinches. We saw mostly yellow flowers.

Compass flowers were everywhere. It looked like most of the flowers were facing east. However, it turns out that it’s the leaves that point east.

Black-eyed Susans competed with the Compass Flowers. Both made it more difficult to spot the male Goldfinches, which are brilliant yellow. We never got a snapshot or video of any of them, though we could see them flitting about at lightning speed.

We also saw a yellow airplane flying repeatedly around and around above fields and over the land surrounding Scott Boulevard. It seemed to be painted both yellow and black, raising the question of whether it’s linked to University of Iowa. It seemed to fly in ellipses from east to west and back. It was a mystery.

Later, my romanticizing imagination led me to think maybe the pilot was drawing a massive compass flower in the air, tracing the path of each petal.

Eventually, Sena said several times she thought the plane was crop dusting, which I pooh-poohed.

After we got back home, I took a close look at the videos I shot of the yellow plane. Using my video editing software, I could mitigate the camera shake artifact and sharpen the still images I got from the best clips.

I found one image which displayed a number on the tail, N942QC. The tail number is an alphanumeric code which identifies a specific airplane. I looked it up on the FAA Registry.

The plane was probably not drawing fanciful ellipses. It belongs to a company called Thompson Aero Inc, which operates in Amana, not far from Iowa City. It’s been in operation for 38 years. The business description says: “This organization primarily operates in the Crop Spraying Services business/industry within the Agricultural Services sector.”

Once again, Sena is right about the importance of mundanity.

Overdiagnosis of Psychiatric Disorders Still Happens

I read an excellent article in Clinical Psychiatry News recently in the Hard Talk section. The title is “A prescription for de-diagnosing” by psychiatrists Nicholas Badre, MD and David Lehman, MD in the July 2022 issue (Vol 50, No. 7).

The bottom line is that too many psychiatric patients have too many psychiatric diagnoses. A lot of patients have conflicting diagnoses (both unipolar and bipolar affective disorder for example) and take many psychotropic medications which may be unnecessary and lead to side effects.

It takes time to get to know patients in order to ensure you’re not dropping diagnoses too quickly. Discussing them thoroughly in clinic or in the hospital is an excellent idea. And after getting to know patients as people, it makes sense to discuss reduction in polypharmacy, which can be quite a burden.

This reminds me of the Single Question in Delirium (SQiD), a test to diagnose delirium by simply asking a friend or family member of a patient whether their loved one seems to be more confused lately. It’s a pretty accurate test as it turns out.

This also reminds me of the difficulty in making an accurate diagnosis of bipolar disorder. I and a Chief Resident wrote an article for The Carlat Report in 2012 (TCPR, July / August 2012, Vol 10, Issue 8, “Is Bipolar Disorder Over-Diagnosed?”) which warned against overdiagnosis of bipolar disorder. Excerpts below:

Some argue that bipolar disorder is actually under-diagnosed. They have support from abundant literature showing that bipolar disorder tends to present more often with depression than mania or hypomania (Judd LL et al, Arch Gen Psychiatry 2002:59(6):530–537). As many as 10% of patients with unipolar depression ultimately are shown to have bipolar illness instead, according to some experts (Goodwin GM et al, Eur Neuropsychopharm 2008:18(7):535–549). (See this month’s Q&A with Claudia Baldassano for more on this.) In addition, a new emphasis on subthreshold mood symptoms and more rapid mood shifts has led some psychiatrists to promote the concept of a “bipolar spectrum disorder” (Youngstrom EA et al, Curr Psychiatry Rep 2010;12(6):479–489).

While it’s important to remain vigilant about a history of manic and hypomanic symptoms, we think the problem of over-diagnosis is probably greater. For instance, in a 2008 study, Zimmerman and colleagues performed a comprehensive diagnostic interview on 700 patients, nearly 21% of who self-reported a history of “bipolar disorder.” However, when using the gold-standard SCID (structured clinical interview), only 13% had the diagnosis; they also had more first-degree relatives with bipolar disorder than the others (Zimmerman M, Ruggero CJ et al, J Clin Psychiatry 2008:69(6):935–940). The authors hypothesized that over-diagnosis of bipolar disorder might be a consequence of efforts to improve recognition of it and avoid under-detection. In fact, the same authors studied 40 depressed patients previously diagnosed with bipolar disorder and found that, by the SCID, they had specific phobia, PTSD, drug abuse/dependence, or a personality disorder instead (Zimmerman M et al, Compr Psychiatry 2010;51(2):99–105).

Over-diagnosis can also occur when apparent mood episodes are defined as psychiatric when in fact, they have a different etiology altogether. Decreased need for sleep, disorganized or racing thoughts, increased activity and agitation, and delusional thinking, even when they occur together, can represent a sort of “final common pathway” for medical conditions and other syndromes. The manic phenotype can occur in patients with agitated delirium, brain tumors, corticosteroid treatment, and of course substance intoxication (Bunevicius A et al, CNS Spectr 2008;13(11):950–958; Brooks JO and Hoblyn JC, Am J Psychiatry 2005;162(11):2033–2038). These other phenotypes can be distinguished by recognition of key features such as the fluctuating nature of consciousness in delirium, neuroimaging findings, and positive urine drug screens.

Unfortunately, physicians may also be susceptible to diagnostic shortcuts. When faced with limited time for diagnostic interviews and the pressure to prescribe by patients and their families, well-meaning clinicians may give the diagnosis after a single brief interview. Not uncommonly, we find that it was diagnosed on the basis of mood fluctuation over minutes, temper tantrums, and fleeting insomnia. The rapidly expanding repertoire of medications approved for bipolar disorder, and their relative ease of use, may also contribute to over-diagnosis. Unfortunately, in some cases the treatment may be worse than the symptoms themselves (Iordache I and Low NC, J Psychiatry Neurosci 2010;35(3): E3–4).

I was accustomed to asking what I called the Single Question in Bipolar (SQiB). I frequently saw patients who said their psychiatrists had diagnosed them with bipolar disorder. I would ask them, “Can you tell me about your manic episodes?”

Often, they looked puzzled and replied, “What’s a manic episode?” I would describe the typical symptoms and they would deny ever having them.

The article by Drs. Badre and Lehman is a bit disappointing in that it doesn’t look as though we’ve improved our diagnostic acumen much in the last decade.

We need to try harder.

Be Quiet and Pay Attention!

I think it was last week that I got this thought about getting attention compared to paying attention. At first, I thought it was original. Hey, did I really just come up with that idea? The see-saw nature of it appealed to me. I write this blog partly to get attention. But I notice that when I pay attention and focus on what I’m writing, it’s more fun.

I quickly gave up the thought that I came up with the idea. I think the context was a little discouragement about the really low traffic to my blog. Now, I’m not just saying that to get more attention—although it does sound like that. And I really appreciate the visits I get from readers!

I searched the web for more about the get attention vs pay attention thing because I was pretty sure I didn’t come up with it but just forgot where I first heard about it.

The funny thing is that what first came to mind was the Men in Black (MIB) scene in which Agent J’s elementary schoolteacher Mrs. Edelson is displayed on the big monitor at MIB headquarters. It turns out she’s actually an alien and she’s crabbing at the class, “…Be quiet and pay attention!” I’ve searched for the YouTube clip but all I found were two: one deleted scene in which her rage at the class went up like a bomb and was way overdone and the other which was blurry and the audio was terrible.

Anyway, you get the idea. Of course, I also found the TED Talk by actor Joseph Gordon-Levitt about paying attention vs getting attention, “How craving attention makes you less creative.”

I think his point is spot on about social media being a big part of the push for many of us to crave attention. I used to have accounts on Twitter, Facebook, and LinkedIn but dropped them years ago because I got almost no traffic. I’m still on YouTube, which has low traffic but which I have fun with because I like making funny little videos. I also made teaching videos back when I was a consulting psychiatrist at University of Iowa Hospitals & Clinics.

I get hardly any traffic on my current blog (which I’ve had for about 3 years) and I get a little frustrated with that. However, I like to write so I’m probably going to hang on to it for a while. I had a previous blog that lasted for about 7 years. It also never got more than a modest number of followers.

When I’m paying attention to what I’m writing about, it may not get any views but I get more satisfaction from writing them. I do my best writing when I’m just having fun doing it. I get a kick out of writing. But then I wonder why I’m not getting any views.

I think the see-saw aspect of paying vs getting attention is normal. So, I should pay more attention to Mrs. Edelson.

Thoughts on the Song “Against the Wind”

A couple of days ago, while we were playing cribbage, Sena asked me who sang the song “Against the Wind.” I offered a name, which later turned out to be wildly wrong. It bugged her so much she got up from the cribbage game and went to the computer to look it up.

Of course, Bob Seger wrote the lyrics and sang it. She asked me what I thought it meant. I wasn’t sure at the time. I hadn’t thought about it for a really long time.

I read about it on the web. I didn’t know what the lyric “8 miles a minute” meant and found a forum message saying that it corresponds roughly to the speed of a cruising airliner which is about a “480 mph.” That’s technically more like 480 knots, which converts to about 550 mph.

Anyway, it’s really fast and might be a way of saying you’re moving through life at breakneck speed. In Seger’s case, it might have had a more concrete meaning, referring to flying all over from concert to concert.

The song was released in 1980, which was about the time we moved to Ames so I could go back to college at Iowa State University (ISU). It was a big change from working as a draftsman and land surveyor’s assistant in my hometown of Mason City.

If you extend the “against the wind” metaphor a little bit, Sena and I were both moving against the wind in terms of our place in society, income level, location and educational attainment. I thought I wanted to be an engineer at the time, mostly because I had worked for years for consulting engineers.

Backing up in time a little, I had done some undergraduate college work previously at an HBCU (historically black college/university), Huston-Tillotson College (now Huston-Tillotson University) in Austin, Texas in the mid-1970s.

That was also a kind of move against the wind. I grew up in Mason City, and often I was the only black kid in grade school. I got used to that, although the racism was more overt back then and it was difficult sometimes to bear up against that kind of wind. On the other hand, I felt like a fish out of water at H-TC. I just felt like I didn’t fit in. It was part of the reason I left Austin.

It was also challenging to fit in at ISU. I figured out quickly that I would never complete the engineering degree program. The math and hard science courses were tough from the beginning and only got harder. I realized I was going against the wind there.

So, I changed my major and settled on medical technology, which led to working in a hospital laboratory. But it took about a year to get a job after graduation. Looking back, It was a frustrating time and that really felt like pushing against a headwind. I don’t know what I would have done without Sena.

I finally got into medical school at the University of Iowa. Biostatistics and Biochemistry were brutal. I was very close to quitting before the 3rd year of clinical rotations. I doubted I was cut out to be a physician. I thought about going back to surveying. But I didn’t.

Many deadlines, commitments, and struggles leading to brief forays from academia into private practice led me to think of myself as more of a fireman or a cowboy than an academician. Yet I spent most of my career at the University of Iowa.

Now I’m retired. Sena is my shelter against the wind. I guess if you look hard enough, just about anybody can relate to Bob Seger’s song. Let the cowboys ride.

Thoughts on the GuideLink Center Incident

The attack a few days ago by what was most likely a mentally ill person on staff at the recently opened GuideLink Center in Iowa City reminded me of what may appear to be disparate views by mental health professionals on the link between mental illness and mass violence perpetrators.

The GuideLink incident involved a person who assaulted GuideLink staff and who also left bags containing incendiary devices at the center and another building in Iowa City. The person is being charged with terrorism and is currently in custody in the Johnson County Jail.

I have not seen information about any injuries sustained by the mental health center staff. There were no explosions or fires at either location where incendiary devices were left. Bomb squad experts removed the devices. It’s not clear whether the perpetrator had been a GuideLink Center client.

The GuideLink Center opened in February 2021 and by all reports is a welcome and very much needed crisis stabilization mental health resource in the community. The staff members are dedicated to their calling.

Dr. H. Steven Moffic, MD, a retired psychiatrist who writes for Psychiatric Times, readily says that the perpetrators sometimes do have mental illness that at least contributes to committing acts of mass violence. Dr. George Dawson, MD, another retired psychiatrist, seems to say that the major reason for mass shootings is the ready availability of guns, a culture of gun extremism, and mental illness accounts for a small proportion of acts of mass violence.

But neither Dr. Moffic nor Dr. Dawson say that it’s only either mental illness or guns (or other instrument of mass violence) that lead to acts of mass violence. Both are important.

I’m a third retired psychiatrist and by now some readers might be asking themselves whether they should listen to any retired psychiatrist. Experience counts.

Speaking for myself, as a general hospital psychiatric consultant I was frequently faced with violent patients in the general hospital. Often, I found it necessary to ask a judge for a court order to involuntarily hospitalize a violent and/or suicidal patient on a locked psychiatric unit by transfer from an open medical or postsurgical unit.

In order to obtain an order in the state of Iowa, I had to be able to state to the judge that the patient in question had a treatable mental disorder and was an acute threat to himself and/others. In most situations, I had an open bed on a locked psychiatric unit available ahead of time.

Even if a Code Green was necessary, I usually had an inpatient resource to which I could move the patient. A Code Green is a show of force or takedown maneuver by a specially trained team to control a violent patient while minimizing injury to everyone involved.

I don’t know if that kind of approach is even possible in a community crisis stabilization setting like the GuideLink Center. I think it’s fortunate that it partners with many other community resources including the Johnson County Sheriff’s Office.

The outcome of the incident at the GuideLink Center was that the overall safety of the staff, the patient, and the community was preserved. More resources like this are needed everywhere. They deserve all the support we can give them.

Do You Get the Zoomies or the Zennies?

Does your pet dog, cat, or sloth ever get the zoomies? We don’t have pets; I just read about animals getting the zoomies the other day. It’s an interesting phenomenon. Right after a bath, a dog might race around the yard, getting all dirty again. They look like they’re having great fun and veterinarians say it’s harmless.

It would be great if we could catch a sloth with the zoomies. Not only would that be a first for zoology. Maybe it would outrun the fungus and other parasites growing on its hair, making it easier to gather by scientists. Some of that stuff might have potential for use in developing medicines for humans.

Other animals including those in the wild can get the zoomies, and some version of it might be done by Springbok antelope, although it’s called pronking. They just run around and leap, maybe for no apparent reason. Some claim that dogs occasionally pronk, but I wonder if it’s just a special case of the zoomies.

The veterinary term for zoomies or (and maybe pronking) is Frenetic Random Activity Periods (FRAP).

Technically, I don’t think humans get the zoomies although some would debate the issue.  Many of us try to do the opposite, especially nowadays. One example is mindfulness, which I’ve been doing for the last 8 years. It’s difficult for me to describe, but you’re really not trying to do anything, not even trying to relax, per se.

But I try to be still and notice whatever is unfolding, nonjudgmentally. It’s a little hard not to scratch that itch right next to my temple. I’ve seen on the web that some people call it the zennies—maybe we could call it Focused Regular Awareness Periods (FRAP).

I guess dogs and cats enjoy their brand of FRAP, or at least it looks that way. It’s really hard to tell what’s going on if you just watch people doing the human brand of FRAP. Sometimes they just look like they might be asleep—which occasionally happens.

Zoomies or zennies; could they be different paths to the same place?

The Kindness of Strangers in a Parking Lot

This is a post about how easy it is to forget where you parked your car in a big parking lot, say at the grocery store, and ways to help prevent it. This sometimes attracts the kindness of strangers, which is puzzling because it’s not very clear how helpful they can be in this situation.

But you want to say more than something like, “Oh, that’s too bad, hope you find it before the ice cream melts.”

The other day, Sena forgot where she parked the car at the grocery store. The circumstances were a little unusual. She parked near one entrance to the store and after getting the groceries, left from an entrance on the other side of the store way across the parking lot. The landmarks were all different.

This is how things started: she ran into a guy with his little boy. The guy actually couldn’t remember where he parked his car and was trying to use his car key fob remote to locate it. This is actually pretty common nowadays. I remember leaving the eye clinic a few months ago and hearing a small symphony of beeps from a number of people using their key fob remotes this way trying to find their cars in the large parking garage.

Sena was sympathetic to the guy, but it was understandably really difficult to help him. He eventually found his car using the key fob trick.

Then the situations were reversed. Sena had trouble finding our car. She was roaming about the parking lot, pushing the grocery cart, obviously looking lost. This attracted 4 different persons (including the first guy she met) who were sympathetic and offered advice—mostly on how to use a key fob to locate the car by pressing one of the buttons (probably the lock/unlock although there might be a panic button). They demonstrated it by pressing the key fob button while standing right next to their cars. They suggested holding it far above your head.

This trick usually works best when you’re fairly close to the car because the key fob remote is a transmitter which uses low-power signals. The operating range may sometimes be limited. Sena was probably pretty far away from our car. She actually began to suspect our car had been stolen. She eventually found it by trial and error.

This episode resulted in attracting a number of people who were kind to her. That’ s encouraging since it looks like kindness is often in short supply. On the other hand, it’s not always good to be alone in a large unfamiliar parking lot, perhaps at night, looking lost and surrounded by strangers.

We can’t remember having this problem years ago before the era of keyless fob remotes, which I read was in the mid-1990s. And we didn’t have them until years after that. I guess we were just more careful about noting landmarks in large parking lots.

There are few things to do in order to avoid forgetting where you park.

You can try to find your car using your key fob remote, although the effective range of the signal might be too short to trigger the horn or the lights. And it might not work if the fob remote battery power is low. And if you’re surrounded by a lot of other people hunting for their cars using the same method, you might have a little trouble discriminating which beep is yours. This could become a YouTube meme, especially with different beep tones (like the 5 tones in the movie “Close Encounters of the Third Kind”).

You can pick a landmark which will make it easier to remember where your car is. Many parking lots have large signs with numbers and letters which can help you.

You can take a picture of your car’s location using your cell phone, including more permanent landmarks than just the other cars adjacent to it—which can be driven off by their owners.

You can also use a cell phone with Google Maps or another geolocation app to help guide you back to your car. Just about all smartphones have this feature. You can consult the owner’s manual for instructions for flip phones, some of which have this function. I don’t think car owners’ manuals typically have instructions for how to use the key fob remotes to find your car. At least ours doesn’t.

Good luck.

Update on James Alan McPherson Park Memorial Plaque

Sena suggested we send a message to Iowa City Mayor Bruce Teague inquiring about the proposed memorial plaque to James Alan McPherson, Pulitzer Prize winning author and longtime Iowa Writers’ Workshop faculty member.

I can remember only one other time in my life that I wrote a letter to an elected official. I wrote President Barack Obama in 2013, basically complaining about the Maintenance of Certification (MOC) program for physicians. I’m not sure what I expected him to do about it. Like many doctors, I was frustrated about the regulatory requirements from certification boards. I thought they were unnecessary and burdensome.

I received a reply which was completely off topic and probably not written by the President. The letter from “President Obama” didn’t answer or even come close to addressing the concerns about what I thought was regulatory harassment. In fact, I never kept the reply and forgot about it.

But the email to Mayor Bruce Teague was different. We just asked about the timeline on the memorial plaque for the James Alan McPherson Park, which was renamed last year. The celebration and ribbon cutting reveal of the new sign was in early August 2021. The memorial plaque was still in the planning stage. We’ve driven by the park several times in the last year looking for it.

Mayor Teague’s reply came the day after we sent our message. It was definitely pertinent and to the point. McPherson’s daughter Rachel is still looking over the wording on the mock-up of the plaque, considering what to include. After her approval, it would take about 10-12 weeks to complete.

Now that’s a quick and specific answer from a political leader. Mayor Teague also sings.

Skimming the Parks

We took a walk on the Hickory Hill Park short Loop and the James Alan McPherson Park. We’ve lived in Iowa City for 34 years and walked only one other Hickory Hill Park trail. That was several years ago.

Just before you start the short Loop, you can read a poem, The Morning by W.S. Merwin.

We also saw a Widow Skimmer Dragonfly for the first time ever. It was spectacular.

We spotted proof positive for Bigfoot—a tree structure. OK, so not proof but interesting all the same.

And we fully noticed the two huge American Sycamore trees flanking the beginning of the walking trail on James Alan McPherson Park.

We also ran into others walking the Loop, often walking their pet animals, including a man with a Bengal cat. We’ve never heard of them. Despite its name, it was spotted more like a leopard than a tiger. It looked like a jungle cat.

It’s a great start to the July 4th holiday. Have a good one.

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