Category: reflections

Remembrance of Dr. William R. Yates MD

I was thinking about the Clinical Problems in Consultation Psychiatry (CPCP) learning sessions which was introduced to me by one of my first teachers in the University of Iowa Dept of Psychiatry, Dr. William R. (Bill) Yates.

I had originally been thinking of posting one of my own CPCPs that I presented in 2015. It was about the psychosocial adjustment of patients to ostomy.

I searched widely and in vain on the web for any recent information about what Dr. Yates was doing now. I was surprised and saddened to discover his obituary. He died on January 19, 2023 in Tulsa, Oklahoma.

As the obituary says:

He served on the faculty at the University of Iowa for Psychiatry and Family Medicine before becoming Professor and Chair of Psychiatry at the University of Oklahoma College of Medicine in Tulsa. After retiring, he continued to dedicate his time as a volunteer research psychiatrist at OU and the Laureate Institute for Brain Research where he also served on the board of directors. He authored over 100 scientific manuscripts that were published in peer-reviewed journals.

He was an energetic, a great teacher, had a great sense of humor, and was easy to get along with. He published in many scientific journals and taught many trainees. He was an avid bird watcher and his blog Brain Posts highlighting neuroscience research findings is still visible on the web.

He published the paper along with a chief resident on problem-based learning used on the psychiatry consult-liaison service in 1996, the year I graduated psychiatry residency and joined the faculty at The University of Iowa Hospitals & Clinics (Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.) You can read the abstract for it along with a description of the CPCP at the link above which takes you to my April 19, 2019 blog post “Clinical Problems in Consultation Psychiatry.”

When he was the leader of the psychiatry consult service, we were still using paper charts and his staffing comments were always very brief and encapsulated the assessment and plan succinctly without wasted verbiage—contrasting with my long-winded note.

His remarks about his role at Laureate Institute for Brain Research is still accessible:

“I work part-time as a research psychiatrist for the assessment team at the Laureate Institute for Brain Research. We do research diagnostic assessments for a variety of imaging, genetic and biomarkers studies in mood, anxiety and other brain disorders. I also provide review and analysis of neuroscience research on my blog Brain Posts that can be found at www.brainposts.blogspot.com. You can follow me on Twitter @WRY999. I also use my blog and Twitter feed to share my bird photography images.”

I respected and admired Dr. Yates, as I’m sure many learners did. I will always remember Bill as a gifted scientist and teacher.

I think a fitting tribute would be to go ahead and post my CPCP on the psychosocial adjustment of patients with ostomy. One of the most interesting articles in the bibliography is how the mindfulness meditation approach to that adjustment can be very helpful. The website United Ostomy Association of America website is also informative.

The presentation is also limited to a dozen slides. I often encouraged learners to keep the number of slides to a managed number so the presentations wouldn’t run too long. I called my slide sets the Dirty Dozens.

Many thanks to Dr. William R. Yates and my condolences to his family.

Hawaii Memories

The wildfires in Maui are so devastating. We wish everyone the best. We also had a wave of nostalgia back to 1997 when we visited the Hawaiian Islands on our first vacation in a long while after I finished my psychiatry residency in 1996.

The plane trip was very long and what I remember most about it, flying all the way from Iowa, was the terrible case of bilateral airplane ear which lasted for a couple of hours after we landed in Honolulu. After that, things got a lot better. It was a long time ago, so the memories are a little hazy.

We remember the bus from the airport stopped at the hotel where the tour guide got out to check the reservations for all of us. It was very hot because the bus driver didn’t want to let the vehicle run so as to allow the air conditioner to cool us off. We were probably the youngest members of the tour group. It was the oldest who complained the loudest, finally convincing the bus driver to start the bus to cool everybody off.

After we arrived at the hotel, it was also the oldest members who had the energy to go out and see Don Ho perform. When they got back, they said he got drunk, but he was able to sing “Tiny Bubbles.” We were too exhausted to go. The oldest group members were often the most energetic.

We went a great little restaurant in either Kauai or maybe it was in Hilo, Hawaii (the Big Island) and got plates of huge shrimp. They were shorthanded on servers and several members of the tour group (again the older ones) pitched in to help out.

We saw the Kodak Hula Show in Honolulu on the island of Oahu. I read a little about it and the show nearly closed in 1999, but it was taken over by the Hogan Family Foundation for three years at a cost of half-million dollars per year. The show closed in 2002 so that the money could be used to fund educational programs.

Of course. we also visited the USS Arizona Memorial at Pearl Harbor. One of our tour group members who was a veteran of that war wept as he read the names. We became friends with him and his wife and sent each other Christmas cards for a few years afterward.

We saw the Hawaii Tropical Botanical Gardens in Hilo, Hawaii. It’s huge. It was a tribute to the Japanese immigrants to The Big Island who helped build its agricultural history beginning in 1868.

We visited the Wailua River State Park Fern Grotto Area and the Waimea Canyon in Kauai. The latter is also known as The Grand Canyon of the Pacific. I think Kauai was where I first tried coffee-flavored ice cream—Kona coffee, I’m sure. It remains one of my favorites, next to plain vanilla.

We got a few photos of the Iao Needle in the Iao Valley on Maui. We went to a big luau, but I can’t remember exactly where it was. I remember I was coming down with a head cold and had a runny nose. We tried poi, and I’m afraid I didn’t find it very tasty—and it had nothing to do with cold.  Maui was the final island to see on our itinerary. I think we saw the huge Banyan Tree in Lahaina because we have a picture of a very large tree with Sena standing in front of it.

The 150-year-old Banyan Tree was charred in the fire, but it’s still standing.

Terry Trueblood Garden of Natural and Not So Natural Things

On a balmy day we went for a walk on the Terry Trueblood trail. There was a cool breeze in contrast to the brutal humidity lately. There was a mix of natural beauty and some not so natural sights.

The flowers were gorgeous as usual. But we also saw stacked stones close to the shore of the lake. I should say there were a couple of stacked stones and one which was made of tree branches that reminded me of the Eiffel Tower.

That was the first time we’ve ever seen stacked stones there. I looked up the topic of stacking stones on the web and there’s disagreement about whether it’s a good thing or not. Some say it disturbs the natural order of things while others say it pays homage to nature.

We saw a couple of people out on the shore and one of them kicked over one of the piles. I guess that’s one person who doesn’t like rock stacking.

We also saw a pair of black hands stamped on the sidewalk. What’s that about? Some say that black hands are about death, criminality, or even the Black Lives Matter movement. I don’t know what it means.

And a couple of the large stones along the edges of the parking lot were shoved out of place. Who knows why. They looked very heavy. It probably took a lot of work to move them, and for no apparent reason. It reminded me of the rocks, some of which weigh several hundred pounds, that seem to move by themselves across the desert in Death Valley Park, leaving trails behind. There’s a natural explanation for it, involving the interplay of ice, wind, and water. I’m pretty sure humans moved them.

Anyway, there was plenty of natural beauty along the trail. They were the only source of wonder we cared about that day.

Wings in the Garden

We’ve got more videos of birds and a butterfly (which I think is a swallowtail) in our garden. The catbirds and oddly, song sparrows (I thought they were rare in our part of the country?) are turning out to be regular visitors. They like the mulberries and spend a lot of time preening. They visit every day and they’re always a welcome sight.

The Lesser-Known Quote by Wonko the Sane

A couple of days ago, Sena and I were playing cribbage and she thought she had a higher scoring hand than she actually did. She immediately realized it and scored it right. She commented that, at first, she thought she saw something she didn’t actually see. I quipped that “First you have to see it.” She thought that was pretty funny.

I actually said that because I remembered a quote from Wonko the Sane in Douglas Adam’s book “So Long and Thanks for All the Fish.” Wonko is a guy who lives “outside the asylum” because he saw the instructions on a box of toothpicks and thought it was so bizarre that he didn’t want to live in a society which needed that kind of instruction.

Now, you can find a lot of references on the web for the quote that arises from the toothpick instruction:

“It seemed to me, said Wonko the Sane, that any civilization that so far lost its head as to need to include a detailed set of instructions for use in a package of toothpicks, was no longer a civilization in which I could live and stay sane.” Douglas Adams, So Long, and Thanks for All the Fish.

You can even buy tee shirts printed with this quote. But that’s not the Wonko the Sane quote I was thinking of. In fact, I’m not the only one who thought of it and the first person I want to give credit to for calling attention to it is a WordPress blogger whose name seems not discoverable on his blog, but instead has the title Eppur Si Muove. It’s Latin and it means “…and yet it does move.” It’s attributed to Galileo who muttered it after being forced to recant his claim that the earth moves around the sun.

The quote is:

But the reason I call myself by my childhood name is to remind myself that a scientist must also be absolutely like a child. If he sees a thing, he must say that he sees it, whether it was what he thought he was going to see or not. See first, think later, then test. But always see first. Otherwise you will only see what you were expecting. Most scientists forget that…. So the other reason why I call myself Wonko the Sane is so that people will think that I am a fool. That allows me to say what I see when I see it. You can’t possibly be a scientist if you mind people thinking that you’re a fool. ~ Wonko the Sane, from So Long, and Thanks for All the Fish by Douglas Adams.

The blogger who wrote the post entitled it “Wonko the Sane—On Being a Scientist…”

Seeing what’s really there is very difficult to do. I’m fettered by expectations, desires, prior misinformation, and so on. Often, I see what I want to see rather than what’s there.

The toothpick quote gets more interpretations often by writers who sound like they trying to prove something. What’s even more interesting than them (and funnier) are the great number of actual instructions on how to use toothpicks, even how to do tricks with them.

What seems impossible to find are actual instructions for how to see.

We Are All Still Learning to Play Pong

I noticed an article the other day about Monash University in Australia getting funding for further research into growing brain cells onto silicon chips and teaching them how to play cribbage.

Just kidding, the research is for teaching the modified brain cells tasks. They succeeded in teaching them goal-directed tasks like how to play the tennis-like game Pong last year. You remember Pong from the 1970s? Shame on you if you don’t. On the other hand, that means you probably didn’t frequent any beer taverns in your hometown while you were growing up—or that you’re just too young to remember.

The new research program is called Cortical Labs and has hundreds of thousands of dollars in funding. The head of the program, Dr. Razi, says it combines Artificial Intelligence (AI) and synthetic biology to make programmable biological computing platforms which will take over the world and bring back Pong!

It’s an ambitious project. The motto of Monash University is Ancora Imparo, which is Italian for “I am still learning.” It links humility and perseverance.

There’s a lot of suspicion out there about AI and projects like the Pong initiative in Australia. It could eventually grow into a vast industry run by robots who will run on a simple fuel called vegemite.

Shame on you if you don’t know what vegemite is!

Anyway, it reminds me that I recently finished reading Isaac Asimov’s book of science fiction short stories, “I, Robot.”

The last two stories in the book are intriguing. Both “Evidence” and “The Evitable Conflict” are generally about the conflict between humans and AI, which is a big controversy currently.

The robopsychologist, Dr. Susan Calvin, is very much on the side of AI (I’m going to use the term synonymously with robot) and thinks a robot politician would be preferable to a human one because of the requirement for the AI to adhere to the 3 Laws of Robotics, especially the first one which says AI can never harm a human or allow a human or through inaction allow a human to come to harm.

In the story “Evidence,” a politician named Stephen Byerley is suspected of being a robot by his opponent. The opponent tried to legally force Byerley to eat vegemite (joke alert!) to prove the accusation. This is based on the idea that robots can’t eat. This leads to the examination of the argument about who would make better politicians: robots or humans. Byerley at one point asks Dr. Calvin whether robots are really so different from men, mentally.

Calvin retorts, “Worlds different…, Robots are essentially decent.” She and Dr. Alfred Lanning and other characters are always cranky with each other. The stare savagely at one another and yank at mustaches so hard you wonder if the mustache eventually is ripped from the face. That doesn’t happen to Calvin; she doesn’t have a mustache.

At any rate, Calvin draws parallels between robots and humans that render them almost indistinguishable from each other. Human ethics, self-preservation drive, respect for authority including law make us very much like robots such that being a robot could imply being a very good human.

Wait a minute. Most humans behave very badly, right down to exchanging savage stares at each other.

The last story, “The Evitable Conflict” was difficult to follow, but the bottom line seemed to be that the Machine, a major AI that, because it is always learning, controls not just goods and services for the world, but the social fabric as well while keeping this a secret from humans so as not to upset them.

The end result is that the economy is sound, peace reigns, the vegemite supply is secure—and humans always win the annual Pong tournaments.

Acts of Kindness Spotted in Walmart!

If you read the news, you rarely find any stories about acts of kindness. Everybody is slamming everybody else. Sena sees acts of kindness at Walmart. Not long ago, a Walmart grocery shopper went out of his way to be kind to her.

She was in the checkout lane of a cashier who greets everyone with a cheery “Did you find everything you want? Thank you for shopping at Walmart!” People actually try to get into her lane, probably to get a dose of her kindness. They will arm wrestle for the privilege, best 2 out of 3 wins.

I rarely go grocery shopping but actually recognized her from Sena’s description and scooted into her lane. She even placed the sacks of groceries up on top of the circle of bags to make it easier for me to grab them, making it less likely to forget them—which is something I would probably do. She’s easy to find; she’s the only one still wearing both a medical grade mask, face shield, and gloves.

Sena almost always encounters kindness from random shoppers and Walmart workers who see her struggling to reach an item on a high shelf. They’ll say “Let me help you with that.”

Anyway, where was I? Oh, the shopper kindness incident. She was in the kind cashier’s lane behind another couple who also prefer this cashier. She had encountered them elsewhere in the store and the guy joked with her about cottage cheese.

There were no dividers to separate Sena’s groceries on the conveyer belt from his, so she used a package of celery and announced it to the cashier—who forgot that and rung it up along with a couple of other items) for the guy and his wife in front of Sena. Sena caught the mistake and they all joked about it.

After the couple left the store with their groceries and as Sena was checking her items, she felt a tap on her shoulder. It was the guy who had been in front of her. He handed her a package of mushrooms, the one item that the cashier had charged to him by mistake and had not caught. He had probably gone all the way out to the parking lot and somehow noticed the mushrooms.

He gave Sena the mushrooms and told her that he didn’t want her to get all the way home and find out that she didn’t have them for a recipe.

Sena knew he’d been charged for them and because she didn’t carry enough cash to pay him back, advised him he could get the mistake fixed at customer service. By this time, it was too late for everyone’s favorite cashier to correct it.

The guy said the transaction was too complicated and not worth standing in the long line at customer service.

But it was worth his while to get all the way out to the parking lot and walk all the way back in to return a $2 package of mushrooms to Sena.

Sometimes, it seems to me we spend more time on the lookout for UFOs in the sky than for human acts of kindness on earth.

Maybe I Should Be More Optimistic About Humans

I read the Psychiatric Times article “How Psychiatry Has Enriched My Life: A Journey Beyond Expectations” by Victor Ajluni, MD and published on July 4, 2023. It was like a breath of fresh air to read an expression of gratitude. Just about everything I read in the news is negative.

At the end of the article, Dr. Ajluni added a comment acknowledging that artificial intelligence (AI ChatGPT) assisted him in writing it. He takes full responsibility for the content, to be sure. I wouldn’t have guessed that AI was involved.

There’s a lot of negative stuff in the news. There are hysterically alarming headlines about AI.

I suppose you could wonder if Dr. Aljuni’s article is intentionally ironic, maybe just because the gratitude tone is so positive.  If it had been intended as irony, what could the AI contribution have been, though? I have a pretty low opinion of the AI capacity for irony.

I think irony occurs to me only because I tend to be pessimistic about the human race.

Maybe that’s because it has been very easy to be pessimistic about what direction human nature seems to be taking in recent years. I’ve been reading Douglas Adams’ satirical book, “The Ultimate Hitchhiker’s Guide to the Galaxy.” It contains several of his books which I think are really about human nature, and the setting is in a funny though often terrifying universe. I think there’s an ironic tone which softens the pessimism. The most pessimistic character is not a human but a robot, Marvin the paranoid android.

Unlike Marvin, I don’t have “a brain the size of a planet” (it’s more the size of a chickpea), but I am getting a bit cynical about the universe. I’m prone to regarding humans as evolving into a race of beings similar to those described in the book “Life, The Universe and Everything.” In Chapter 24, Adams describes the constantly warring Silastic Armorfiends of Striterax.

The Silastic Armorfiends are incredibly violent. Their planet is in ruins because they’re constantly fighting their enemies, and indeed, each other. In fact, the best way to deal with a Silastic Armorfiend is to lock him in a room by himself—because eventually he’ll just beat himself up.

In order to cope better, they tried punching sacks of potatoes to get rid of aggression. But then, they thought it would be more efficient to simply shoot the potatoes instead.

They were the first race to shock a computer, named Hactar. Possibly, Hactar was an AI because, when they told Hactar to make the Ultimate Weapon so they could vanquish all their enemies, Hactar was shocked. Hactar secretly made a tiny bomb with a flaw that made it harmless when the Silastic Armorfiends set it off. Hactar explained “…that there was no conceivable consequence of not setting the bomb off that was worse than setting it off…”, which was why it made the bomb a dud. While Hactar was explaining that it hoped the Silastic Armorfiends would see the logic of this course of action—they destroyed Hactar, or at least thought they had.

Eventually, they found a new way to blow themselves up, which was a relief to everyone in the galaxy.

There are similarities between Hactar and the AI called Virtual Interactive Kinetic Intelligence (V.I.K.I.) in the movie “I, Robot.” The idea was that robots must control humans because humans are so self-destructive. Only that meant robots had to hurt humans in order to protect humanity. The heroes who eventually destroy V.I.K.I. make up a team of misfits: a neurotic AI named Sonny, a paranoid cop who is himself a mixture of robot and human, and a psychiatrist. Together, the team finally discovers the flaw in the logic of V.I.K.I. Of course, this leads to the destruction of V.I.K.I.—but also to the evolution of Sonny who learns the power of the ironic wink.

Maybe kindness is the Ultimate Weapon.

Raccoon in the Mulberry Tree

I was not sure what exactly I saw this between 6:30 and 7:00 this morning shaking the mulberry tree branches in our backyard. It seemed too big to be a squirrel and I dismissed the thought, telling myself that it was most likely the usual squirrel getting its mulberry breakfast.

Just prior to this incident, I had seen and heard what I thought was a blue jay in the mulberry tree. It gave a series of short whistles while bobbing up and down on the branch. I had never heard a blue jay make whistle notes, just the usual screeches. I doubted what I saw and heard. I checked my bird book, “Birds of Iowa: Field Guide” by Stan Tekiela. It didn’t mention anything about blue jays making short whistling notes and bobbing up and down as they did so. I didn’t bother to get up and try to get a video of it. It would have been through the window of our sun room and the jay didn’t sit for more than a few seconds.

So, I looked it up on the web. It turns out blue jays make a variety of noises besides the jeer. They bob up and down as a part of a courtship ritual. They make what is termed a “pump handle call” and I found a video which duplicates what I saw and heard.

Anyhow, getting back to the critter in the mulberry tree, it turned out to be a large raccoon. It was eating mulberries and I tried to take video of it as it was climbing down the tree. This reminded me of an essay by E.B. White entitled “Coon Tree.” If you’ve ever read essays by E.B. White, you probably know already that this one is about a lot more than raccoons.

It’s basically about the conflict between nature and technology. The main essay was published in 1956 and a post script was added in 1962. The coon represents nature which White idealizes and contrasts with references to new inventions, including nuclear devices which represent the destructive side of technology.

I guess we can forget for the moment that raccoons can carry diseases like rabies and roundworm. I’m also reminded of an old TV commercial in the 1970s about margarine (an alternative to butter) in which an actor says angrily, “It’s not nice to fool Mother Nature!” The idea was that margarine (which was a new invention in the late 19th century) was healthier than the natural spread, butter—although the trans fat in it makes the comparison a bit more complicated.

White also says something interesting about unsanitary homes, claiming that children who live in them become more resistant to certain diseases like polio than the kids who grow up in clean homes. The polio scourge raised its ugly head recently in New York, which renewed the recommendation by the Centers for Disease Control recently that people who didn’t get vaccinated against polio should get vaccinated—regardless of how dirty your home was.

And then there is the artificial intelligence (AI) technology. I wonder what E.B. White would say about that? AI can improve detection of some diseases and assist in medical research. On the other hand, AI can still make mistakes and it needs human surveillance.

I read you can sometimes use loud noises to keep raccoons out of your yard. For example, you could try recordings of blue jays.

What Do the Personal Brain Specialists Recommend?

Dr. George Dawson’s post “The Freak Show” reminded me of how coarse and cruel we can be to each other, even when we’re not aware of it. Maybe I should say especially when we’re not aware of it. Dr. Dawson emphasizes the importance of the empathic approach. In the same way, Dr. Moffic in the articles in his column, “Psychiatric Views on the News” draws attention to the need for a socially responsible way for us to relate to one another. The Goodenough Psychiatrist blog expresses poignantly the emotional and courageously humanistic ways we can (or could) relate to each other. Dr. Ronald Pies has highlighted the importance of how human interaction with artificial intelligence must help us find a way to treat each other with respect, and teach that to AI because AI learns from humans.

This reminds me of a character in the book “The Hitchhiker’s Guide to the Galaxy” by Douglas Adams. The character is named Gag Halfrunt who is the personal brain specialist for a couple of other characters. In fact, he’s a psychiatrist who orders the destruction of planet Earth, which is a sort of computer program designed to give us the ultimate question to the ultimate answer for life, the universe, and everything. The reason Gag Halfrunt wants to destroy Earth is, if the ultimate question is revealed, it would put psychiatrists out of work because then everyone would be happy.

Just as a personal comment, I’m pretty unhappy with the author’s position on psychiatrists in general, which tends to overemphasize our importance. And I’m pretty sure psychiatrists are not that important, having been employed as one for many years and seeing how much impact of any kind we have. We can’t make people more or less happy at all.

In fact, Adams also takes a shot at philosophers, who are also upset at being thrown out of work should the ultimate question to the ultimate answer be revealed (the ultimate answer, by the way, is 42 if you’re interested).

Giving psychiatrists and philosophers and anyone else who might have a stake in taking credit for making people happy is nonsense. We all bear responsibility for ourselves. You can argue about whether or not we have any responsibility for each other.

Rather than arguing about it, we could give something else a try. We could try a mindfulness approach like the Lovingkindness Meditation. I’m not an authority or expert on this, but you can check it out on the Palouse Mindfulness website, the link to which is in the menu on my blog. You can find the link to the Lovingkindness Meditation there.

There is no guarantee the Lovingkindness Meditation will make you or anyone else happy. But it doesn’t hurt anything to try it and, as far as I know, Gag Halfrunt is not opposed to it.