reflections – Page 24 – Go Retire Psychiatrist

Maybe We Need a Dose of Humor

Sena and I were listening to the Mike Waters morning radio show (KOKZ 105.7) this morning and his invitation to listeners was to call in and quote their favorite dumb question. One of the callers recited something which was actually a George Carlin joke. Neither one of us thought we heard it right, but it’s the same framework as the joke I found on the web (only the numbers were changed):

“If you’ve got 24 odds and ends on the table and 23 of them fall off, what’ve you got? An odd or an end?”

This is an example of his wordplay humor.

Carlin’s humor was also marked by satire on American culture and politics, the latter of which has gotten pretty rough. You’ll also find references on the web to Carlin’s past history of substance use, which reportedly included psychedelics.

That reminds me of an opinion piece published in the September issue of Current Psychiatry, by the journal’s editor, Henry A. Nasrallah, MD (From neuroplasticity to psychoplasticity: Psilocybin may reverse personality disorders and political fanaticism. Current Psychiatry. 2022 September, 21(9): 4-6 | doi: 10.12788/cp.0283).

I was a little surprised at Dr. Nasrallah’s enthusiastic endorsement of psilocybin for treatment of personality disorders and political extremism. He acknowledges the lack of any studies on the issue. In the last paragraph of his essay is a sweeping endorsement:

In the current political zeitgeist, could psychedelics such as psilocybin reduce or even eliminate political extremism and visceral hatred on all sides? It would be remarkable research to carry out to heal a politically divided populace. The dogma of untreatable personality disorders or hopelessly entrenched political extremism is on the chopping block, and psychedelics offer hope to splinter those beliefs by concurrently remodeling brain tissue (neuroplasticity) and rectifying the mindset (psychoplasticity).

While I’m not so sure about how effective psilocybin would be for this, I’m all for trying something to reduce the “visceral hatred on all sides.”

Maybe humor could be part of the solution. It doesn’t have to be exactly like that of George Carlin. Both parody and satire have been used by many writers for this.

I like the distinction between parody and satire in one article I found on the web. One recent example of satire (or parody; the distinction is sometimes hard to make since the story was listed as “Iowa Parodies”) was in the news and it apparently fooled at least a few people. It was about the Iowa football coaching staff. The title was “Brian Ferentz Promoted to University President To Avoid Having to Fire Him (Satire): The move was deemed ‘a way easier conversation than having him fired’ by the athletic director. It was written by Creighton M, posted September 5, 2022.

I think the story was originally printed without the word “Satire” in the title. I can’t recall seeing the heading “Iowa Parodies” either. A later version of the story added the word “Satire.”

The story might have been about nepotism in the hiring of Brian Ferentz (he’s the son of head coach Kirk Ferentz) as offensive coach. On the other hand, under Iowa law, it was not illegal to hire Brian Ferentz, who in any case reports to athletic director Gary Barta, not Kirk Ferentz.

I suspect the joke had more to do with negative public attitudes about the performance of the Iowa football offense early in the season.

Is it funny? I guess it depends on your perspective. The Iowa football coaching staff probably didn’t chuckle over it. But it more or less fits the definition of satire. It uses humor to expose flaws in the way we behave. And it avoids direct and nasty confrontation, which usually triggers antagonism rather than collaboration. Will it change the Iowa football program? I doubt it. They’re actually doing pretty good so far.

But satire as a strategy to inform and maybe change the public opinion will endure. The Hitchhiker’s Guide to the Galaxy by Douglas Adams is one of my favorite books and it satirizes governments and the foolishness of people. I first learned about The Onion newspaper while we were in the process of relocating to Wisconsin (a short adventure). It satirizes the Associated Press news style.

One of the most uproarious examples of parody is a TV show which is no longer available on cable television but still offered on a streaming service (I think), Mountain Monsters. It’s a hilarious sendup of all the Bigfoot hunter shows.

The added benefit of parody and satire and other such forms of humor is that they are safer than psychedelics—unless your target was born without a funny bone.

Look on the Bright Side

Yesterday was the first day of Autumn. Happy Autumn! Was that too cheerful? You know, I used to watch the show Monty Python’s Flying Circus years ago. I thought it was outrageously funny.

What reminded me of the show was Sena telling me that on Wednesday night, a member of the Flying Circus cast, Eric Idle, was on The Masked Singer, one of her favorite shows. I didn’t watch it. He was Hedgehog and sang the Beatles number, “Love Me Do.” Eric said something about how you should look on the happy side of life. He mentioned there was song with that title.

We looked it up and found “Look on the Bright Side of Life.” It’s a catchy tune and reminded me of Monty Python’s Flying Circus attitude. I guess Eric Idle wrote the song and sang it on The Life of Brian.

While the song seemingly is about looking steadily on the bright side of life, it has that slightly edgy, ironic attitude to it which was typical of the Flying Circus.

While some think that the Covid-19 pandemic is over (not mentioning names), there’s probably a more balanced way of looking at that and other challenges in life. The PennStateExtension published an article on June 12, 2020, “Realistic and Optimistic: Managing Mindset in Challenging Times,” by Suzanna Windon, Ph. D, Assistant Professor, Youth and Adult Leadership, and Mariah Stollar, Former Part-Time Research Assistant, Penn State University.

Their list of ways to look on the bright side while being mindful of potential pitfalls attributable to things like overweening pride and fantasy are good to remember in these trying times (see original article by the authors for full details):

“Practice mindfulness.
Observe and adjust your patterns of thinking.
Believe in yourself, but do not underestimate challenges.
Look forward to the future, but be realistic things may not quickly change.
Keep yourself informed, but limit media intake.
Reflect on messages you are sending to employees, volunteers, and loved ones. ”

In other words, look on the bright side but don’t kid yourself.

Thoughts on Suicide Risk Assessment

I know the term “suicide risk assessment” sounds very clinical. That’s because I did it for many years as a consultation-liaison psychiatrist in the general hospital.

The human part of it was using the suicide safety plan, which I got from the Centre for Applied Research in Mental Health & Addiction (CARMHA). You can download it yourself and adapt it by writing in the National Suicide Prevention Lifeline: 988 Suicide and Crisis Lifeline. That’s because the phone numbers on the form are specific to Canada.

Most often I interviewed patients in the intensive care units, where they were admitted after a suicide attempt. The interviews were very short if they refused to talk to me or were still delirious—often the case.

If they were awake and able to converse, the interviews were often pretty long. One way to connect with the patient was working on the safety plan together. I was often able to tell whether they were sincere or not by the level of detail they gave me about support persons they could get in touch with or things they could do to help them cope with whatever was troubling them.

A lack of detail in the plan, or refusal to work on some parts of it were areas of concern. If there were comments about friends, pets, or pastimes that spontaneously led to laughter (yes, that happened occasionally!), I was more confident that the patient was able to look toward the future and make specific plans for staying alive.

There is healthy debate about how useful specific suicide risk assessment scales are for predicting and preventing suicide. They are an essential part of the computerized medical records now, whatever anyone thinks of their reliability at predicting imminent suicide. I never used no-suicide contracts because well before the time I entered professional practice, most experts agreed that they don’t prevent suicide.

What was more useful for me as a clinician was to sit down at the patient’s bedside and, after getting the details about what the patient actually did in the suicide attempt and the events connected with it (along with a comprehensive and thorough history), I would get the safety plan from my clipboard, hold it up so they could see it and say, “Now let’s work on this; it’s your safety plan.”

I can’t tell you how often working on those plans, frequently for more than half an hour, led to laughter as well as tears from the patient. When it worked, meaning the relationship between us deepened, I sometimes did not find it necessary to admit the person to the psychiatric ward. While this occasionally alarmed the ICU nurses, things usually turned out fine later.

What Would Make Psychiatry More Fun?

I just read Dr. George Dawson’s post “Happy Labor Day” published August 31, 2022. As usual, he’s right on the mark about what makes it very difficult to enjoy psychiatric practice.

And then, I looked on the web for anything on Roger Kathol, MD, FACLP. There’s a YouTube video of my old teacher on the Academy of Consultation-Liaison Psychiatry (ACLP) YouTube site. I gave up my membership a few years ago in anticipation of my retirement.

I think one of my best memories about my psychiatric training was the rotation through the Medical-Psychiatry Unit (MPU). I remember at one time he wanted to call it the Complexity Intervention Unit (CIU)—which I resisted but which made perfect sense. Medical, behavioral, social, and other factors all played roles in the patient presentations we commonly encountered with out patients on that unit where we all worked so hard.

Dr. Kathol made work fun. In fact, he used to read selections from a book about Galen, the Greek physician, writer and philosopher while rounding on the MPU. One day, after I had been up all night on call on the unit, I realized I was supposed to give a short presentation on the evaluation of sodium abnormalities.

I think Roger let me off the hook when he saw me nodding off during a reading from the Galen tome.

Dr. Dawson is right about the need to bring back interest, fun and a sense of humor as well as a sense of being a part of what Roger calls the “House of Medicine.” He outlines what that means in the video.

What made medicine interesting to me and other trainees who had the privilege of working with Roger was his background of training in both internal medicine and psychiatry. He also had a great deal of energy, dedication, and knew how to have fun. He is a great teacher and the House of Medicine needs to remember how valuable an asset a great teacher is.

On the Other Hand Thoughts on HBCUs

Historically Black Colleges and Universities (HBCU) are in the news lately. It reminds me of the short time I spent at Huston-Tillotson College. It was renamed Huston-Tillotson University (H-TU) in 2005. I was there in the mid-1970s.

A new President and CEO was just named this month, Dr. Melva K. Williams. And H-TU was recently added to the National Register of Historic Places last month. It has been renovated and modernized. Pictures show a well-kept campus pretty much as I remember it over 40 years ago. I didn’t graduate from H-TU, but instead transferred credits to Iowa State University where I graduated in 1985.

My favorite teacher was Dr. Jenny Lind Porter-Scott, who was white, taught English Literature. Another very influential teacher was Reverend Hector Grant who was black. He taught philosophy and religion. He was instrumental in recruiting me to matriculate at H-TU. He helped me to process my loss on the debating team when the question was whether or not the death penalty played any role in the reduction of crime.

My opponent won the debate mainly because he talked so much, I couldn’t get a word in edgewise. I can’t remember which side of the question I argued, but I thought I could have done better if he had just shut up for a few minutes and let me speak. Reverend Grant used the word “bombastic” in describing the approach my opponent used. On the other hand, he also gently pointed out that sometimes this can be how debates are won.

There’s this “On the other hand” tactic in debating and in reflective thought that my debating opponent managed to repeatedly deflect.

I don’t know what ever happened to Reverend Grant. We spoke on the telephone years ago. He sounded much older and a hint of frailty was in his voice.

I could find only a photo on eBay of a man who closely resembles the teacher I knew and the name on the picture is Reverend Hector Grant. The only other artifact is a funeral program for someone I never knew, which lists Reverend Hector Grant as being the pastor and some of the pallbearers were members of one of the Huston-Tillotson College fraternities.

I think it’s unusual for people to disappear like that, especially nowadays when we have the world wide web. Reverend Hector Grant was an important influence for me. He was one of the few black men of professional stature I encountered in my early life.

On the other hand, contrast that with Reverend Glen Bandel, another clergyman who was a white man and another important influence starting in my early childhood. Reverend Bandel persuaded me to be baptized at Christ’s Church in Mason City, Iowa. He radiated mercy, generosity, and kindness. He died in June of this year. I can find out more about him on the web just from his obituary than I can ever find on Reverend Grant, who apparently disappeared from the face of the earth.

Both of these men were leaders for whom skin color didn’t matter when it came to treating others with respect and civility.

My path in life was largely paved by these two clergymen. Reverend Bandel sat up with our family one night when my mother was very sick. His family took me and my little brother into their home when she was in the hospital.

On the other hand, Reverend Grant was instrumental in guiding me to an HBCU where I saw more black people in a couple of years than I ever saw in my entire life. The First Congregational Church in Mason City was instrumental in making that possible because they helped fund the drive to support H-TU (one of six small HBCUs) by the national 17/76 Achievement Fund of the United Church of Christ.

The news is replete with stories, some of them tragic, about how Greek fraternities haze their pledges. On the other hand, H-TU was pretty rough on pledges too. Upper classmen would make the pledges roll down the steep hills around the campus. They looked exhausted, wearing towels around their necks, running in place when they weren’t running somewhere in the Texas heat.

One H-TU professor said that H-TU was “small enough to know you, but big enough to grow you.” Although I can’t remember ever seeing him on campus because he was traveling most of the time, I at least knew the name of the President was John Q. Taylor (1965-1988). On the other hand, when I transferred credit to Iowa State University, I never knew the name of the President of the university.

Habari Gani is Swahili for “What’s the news?” or as it translated in the context I’m about to set, “What’s going on?” Habari Gani was the name for the annually published book of poetry by the H-TU students. Dr. Porter supported the project. I submitted a poem for the 1975 edition, which didn’t make the cut. When I transferred to Iowa State University, I left without getting a copy.

On the other hand, years later, I got a digital copy of that edition. I tracked it down to the H-TU library in 2016. The librarian was gracious.

Habari Gani has always been a reminder of the reason why I went to H-TU in the first place. I grew up in Iowa and was always the only black student in school. I grew up in mostly white neighborhoods.

On the other hand, when I finally got to H-TU, one of the students asked me, “Why do you talk so hard?” That referred to my Northern accent, which was not the only cultural factor that made social life challenging.

Once I tried to play a pickup game of basketball in the gymnasium. I’m the clumsiest person for any sport you’ll ever see. I was terrible. But the other players didn’t give me a bad time about it. They softly encouraged me. This was in stark contrast to the time I played a pickup game with all white men years before in Iowa. When I heard one of them yell, “Don’t worry about the nigger!” I just sat down on the bleachers.

On the other hand, when I was a kid and our family was hit by hardship, Reverend Bandel was the kindest person on earth to us—it didn’t matter that he was white. And my 2^nd grade teacher, who was black (the only black teacher I ever had before going to H-TU), slapped me in the face so hard it made my ears ring—because I was rambunctious and accidentally bumped into her. It’s far too easy to polarize people as good or bad based on the color of their skin, especially when you’re young and impressionable.

It takes practice and experience to learn how to say and think, “On the other hand….”

Thoughts on Doctors Going On Strike

I read Dr. H. Steven Moffic’s two articles in Psychiatric Times about the strike by mental health workers at Northern California Kaiser Permanente (August 16 and 26, 2022). So far, no psychiatrists have joined the strike.

However, this piqued my interest in whether psychiatrists or general physicians have ever gone on strike. I have a distant memory of house staff voicing alarm about a plan by University of Iowa Hospital & Clinics to reduce health care insurance cost support many years ago. It led to a big meeting being called by hospital administration to discuss the issue openly with the residents. The decision was to table the issue at least temporarily.

It’s important to point out that the residents didn’t have to strike. I don’t recall that it ever came up. But I think hospital leadership was impressed by the big crowd of physician trainees asking a lot of pointed questions about why they were not involved in any of the discussions leading to the abrupt announcement that support for defraying the cost of house staff health insurance was about to end.

That’s relatively recent history. But I did find an article on MedPage Today written by Milton Packer, MD (published May 18 2022) about what was called the only successful strike by interns and residents in 1975 in New York. I don’t know if it included psychiatric residents; they weren’t specifically mentioned.

In 1957, the Committee of Interns and Residents (CIR) in New York City and voted to unionize to improve appalling working conditions. They won the collective bargaining agreement, the first ever to occur in the U.S. because they went on strike, which hamstrung many of the city’s hospitals. Medical faculty had to pitch in to provide patient care.

After 4 days, the hospitals agreed to the residents’ demands. However, the very next year, the National Labor Relations Board ruled that residents were classifiable as “students,” not employees, which meant they weren’t eligible to engage in collective bargaining. This led to a reversal of the gains made by the strike.

Residents who are unionized voted to strike at three large hospitals in California in June of this year. They reached a tentative contract deal at that time. The news story didn’t mention whether there were any psychiatrists in the union.

There has never been a union of residents at The University of Iowa Hospitals & Clinics. I was a medical student and resident and faculty member for 32 years. I saw changes in call schedules and work loads that were the norm for the exhausting schedules that led to horrors like the Libby Zion case in New York.

Even as a faculty member on our Medical-Psychiatry inpatient unit, the workload was often grueling. I co-attended the unit for years and during the months I was scheduled to work there I shared every other night call with an internist for screening admissions. I was sometimes scheduled for several months at a time because it was difficult to find other psychiatrists willing to tackle the job.

If residents had wanted to unionize and voted to strike then, my internist colleague and I probably could have filled in for them.

But I would never have considered going on strike myself. It would have been next to impossible to find any other psychiatrist to fill in for me. And if other psychiatrists had gone on strike? We might have won a better deal—but only by hurting the patients and families who needed us.

I suspect my attitude is what underlies the impressions shared in Robert G. Harmon’s article, “Intern and Resident Organizations in the United States: 1934-1977,” in the 1978 issue of the Milbank Quarterly.

The house-staff choice of unionization as a formal process has disturbed some health professional leaders. One has pointed out that for a house officer to don another hat, that of striking union member, in addition to those of student, teacher, administrator, investigator, physician, and employee, may be a regrettable complexity that will further erode public confidence in physicians (Hunter, 1976). Others have seriously questioned the ethics and morality of physician strikes (Rosner, 1975). -Milbank Memorial Fund Quarterly/Health and Society, Vol. 56, No. 4, 1978.

When I graduated from medical school, I believed in the cultural view of the physician as a professional. My first allegiance was to the patient and family. I paid dearly for holding that stance. Sena reminds me of the times my head nearly dropped into my soup when I was post call. And I did struggle with burnout.

But I retired because I thought it was time to do so. I don’t think of it as a permanent strike. I hope things turn out all right.

59th Anniversary of MLK’s “I Have a Dream” Speech on August 28, 1963

Sena reminded me that today is the 59th Anniversary of Reverend Martin Luther King Jr’s “I Have a Dream” speech in Washington, D.C. After she reminded me about it, I found this anniversary mentioned in only a few headlines on the web.

But that’s no excuse. It doesn’t matter that I was just a small child on August 28, 1963. And when I hear the speech, it still makes the hair on the back of my neck stand up.

Memories and Condolences

I was thinking of my hometown, Mason City, for some reason today. Then I just happened to think of my childhood pastor, Reverend Glen Bandel. The last time I looked him up on the web was about a year ago and saw a news item dated in 2019. He was celebrating his 90th birthday.

I looked him up today. He died on June 3, 2022.

My deepest condolences to the Bandel family. Reverend Glen Bandel was the definition of the caring family pastor in Mason City. He sat up in the chair with us nearly all night at our house when my mother was sick and my brother and I were little. He had a great sense of humor. The Bandels shared their home with us when times were hard.

They took us with them to visit a family up in Minnesota one winter. I don’t think my mother was with me and my little brother at the time. I think she was in the hospital and the Bandel family took us in.

The family in Minnesota lived and worked on a farm. They didn’t have indoor plumbing. I think Reverend Bandel had a particular reason to visit them. It might have been to try to persuade them to change the way they lived. They had several children.

I had to use the outhouse at night. I was too cold to move my bowels. My family was poor, but not as poor as this one.

I caught the father singing to his little baby daughter. I think the baby’s name was Dolly because he was singing “Hello Dolly” to her. I walked in on them while he was singing the lyric “It’s so nice to have you back where you belong.”

He was having a great time singing to her. But when he looked up and saw me watching him acting like a doting dad, he stopped and looked a little sheepish. I wished he hadn’t seen me.

Reverend Bandel was a hero in the eyes of the many people he served and in my eyes for sure.

I will remember him and the rest of his family for their kindness and generosity as long as I live.

Iowa State Fair Remembers Chet Randolph

The other day Iowa PBS remembered former Iowa PBS Market to Market host Chet Randolph with a flashback to his 1978 Reflections on the Iowa State Fair. His point about the Iowa farmers and the role of agriculture in this state is well taken. We enjoy the Fair because of Iowa farmers, who may enjoy it in a different way than most fairgoers.

According to Bob Quinn’s story in 2002 upon Randolph’s death, the icon of Iowa agriculture set a great example of how to respect the opinions of others while defending your own and be ready to accept “a better answer.”

Chet started out in Mason City, Iowa as a farm news broadcaster and in his early days, he made part of his show an offer to do chores for farm families who otherwise would never have had the time to take a vacation. He spent about 16 years (1975-1990) hosting Market to Market back when it was first called Farm Digest in 1974.

Picture credit of Chet Randolph “choreboy” Gene Champ.

All About the Potato Salad

I recently got a checkup for my retinal tear surgery about 4 months ago. My surgeon was pleased with the outcome. Partly based on my good outcome, he shared that he was guiding his trainees on the wisdom of not necessarily always going with the new surgical procedures for the disorder, which happens not infrequently in those over the age of 50.

In fact, the trend seems to be to do more than just the oldest operation, which is the scleral buckle, in favor of adding vitrectomy as well—a relatively newer approach. I got the scleral buckle.

Progress is good. But just because something is old doesn’t mean it’s outmoded.

We saw the Iowa State Fair episode on old farm machinery the other night. It showed how much progress has been made in farming over many years. However, those old machines replaced a lot of hard labor, so they were definite improvements back in the day.

You can learn something new and valuable by considering what is old. We saw a short film called The Foursome. On the surface, it’s about 4 old guys who have played golf together at an annual tournament for 50 years in Waukon, Iowa. Waukon is in the Northwest part of the state, close to the Mississippi River, which borders the eastern side of the state.

The show is not really about golf, of course. But before it came on, I almost decided not to watch it because of that misconception. The description gives it away, saying that it’s about friendship, small towns, golf—and potato salad.

I think it’s also about getting older. Not everybody ages gracefully and I’m including myself as a pretty good example. I’m not so sure about my memory or my hearing these days. I can stand on one leg for 20 seconds. But one day not too long ago I cracked an egg and instead of emptying the contents into the poaching pan, I dumped them on a paper towel on the countertop. I was mortified.

Sena covered for me and brushed it off, saying it was because we had been talking about the finer points of poaching eggs and I just got distracted, and some hogwash about how she’s done that too. Maybe.

In the film, one of the Foursome was showing some of the artwork he has on the walls at his home. He stopped at one and seemed to fall into some kind of reverie. The camera operator had to sort of whisper to the guy that he needed to move on.

Let’s change the subject and talk about potato salad. They filmed the wife of one of the guys making this potato salad, the recipe for which you can get for free on the web. She used Miracle Whip instead of Mayonnaise. I pointed this out to Sena, who said nothing. Miracle Whip has been around since the 1930s and I grew up eating it on sandwiches at home. I favored it over Mayonnaise.

There has not been a jar of Miracle Whip in our house in almost 45 years—which is how long we’ve been married. I have learned to like Mayonnaise.

This reminds me of one segment on the film showing the wife of one of the other guys shopping for food (including burgers, chips, and whatnot as well as potato salad fixings) for the cookout, a part of the annual golf outing for the four guys. She said it really didn’t matter what she got because “They’ll eat anything you put in front of them.”

Some of them will eat nothing but the potato salad.

There is something poignant about the irascibility alternating with poignancy in the film. Their friendship is deep enough to move one of the four guys to tears. At least that’s what it looked like.

They have the usual flaws men have, including the tendency to be stoic in the face of oncoming frailty and the specter of death.

I don’t know if I’ll age as well as they do. But I do know I will never take up the game of golf. And I wonder if you can substitute Mayonnaise for Miracle Whip in that potato salad.

One thing I’m sure of, Sena is my best friend.