I want to give a shout out to Dr. George Dawson for his post today “The Autocratic Approach to Homelessness” in reference to President Trump’s most recent executive order, “Ending Crime and Disorder on America’s Streets.” As a retired psychiatrist, I look back and remember seeing the problem of the homeless mentally ill a lot. You can read my take on it from last summer’s posts:
I spend a lot of time joking around on my blog, but this is no joking matter. I think the President gets it wrong.
I just noticed something about one of my YouTube videos that I made sort of as a combination gag and educational piece about pseudobulbar affect. It needed a couple of updates—one of which is minor and which I should have noticed 10 years ago when I made it.
It’s a pseudo-rap performance (badly done, I have to agree although it was fun to make), but it’s one of my most watched productions; it has 18,000 views.
One minor update is about the word “Dex” in the so-called lyrics of this raggedy rap song (see the description by clicking on the Watch on YouTube banner in the lower left-hand corner). It stands for dextromethorphan, one of the ingredients along with quinidine in Nuedexta, the medication for pseudobulbar affect. Dextromethorphan has been known to cause dissociation when it’s abused (for example, in cough syrup).
The most important update is about Dr. Robert G. Robinson, who I joked about in the piece. He passed away December 25, 2024. He was the chair of The University of Iowa Dept. of Psychiatry from 1999-2011. He was a great teacher, mentor, and researcher. He published hundreds of research papers and books on neuropsychiatric diseases like post-stroke depression and pseudobulbar affect. He lectured around the world and was widely regarded as a brilliant leader in his field.
Early in my career in the department, I left twice to try my hand in private practice psychiatry. Both times Dr. Robinson welcomed me back—warmly. He was my co-editor of our book, Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry, published in 2010.
All who worked with Dr. Robinson will never forget him.
Here’s something fun, try to explain what the phrase “in the pocket” means. The song selections in the pod show led up to a short discussion of what it means—which I didn’t get at all. I don’t think it matters for the ordinary listeners, although former music teachers like Big Mo obviously know what the term means. He taught music for years, has performed, and uses the lingo to explain what “in the pocket” is all about. It’s way over my head, but then I don’t need to know anything about it to enjoy music.
I tried to look up the meaning of the terms “in the pocket” on the web. I took a quick look at a website called Sage Audio. The title is “What is In-the-Pocket for Music?” I couldn’t find the author’s name because I didn’t see a byline. It’s very long and technical and seems geared for sound engineers. One sentence by the writer caught my attention under the heading “What is In-the-Pocket for Music in Detail”:
“It isn’t uncommon to hear a music term and wonder what it means exactly. Becoming well versed in music means understanding its discourse, which can certainly be easier said than done.”
Here’s how far out in left field I am. Depending on how I read that, I’d almost recast the last part of that sentence: “…which can certainly be easier done than said.” I realize the sense of it is that becoming adept in making music means understanding the lingo. I just don’t understand the lingo, which makes me wonder if musicians have some kind of inner body sense for timing in music as it’s performed which may not readily translate to language for the layperson.
I was like a lot of other students in junior high music class. We were pretty good at whispering or half-mumbling the songs we were supposed learn to sing out loud. That really annoyed the music teacher. I don’t know if Big Mo can relate to that or not. We were supposed to learn the song “Sloop John B.” I’m not sure if we were doing the Beach Boys version or the original “The John B. Sails.”
It hardly mattered. We sounded like we ate up all the corn and held it in our mouths while mumbling. We just stuck our hands in our pockets, moaned the words, and were never in the groove. I don’t think a metronome helped. In fact, I’m not sure there was a metronome.
I have to mention that I probably was too young to know that the song by Little Ed and the Blues Imperials, “Walking the Dog,” was about a kind of dance. I never danced although most of the dancing kids on American Bandstand had the same answer to Dick Clark’s question on what they liked about the song—it was always “the beat.” I guess they knew that meant the number was “in the pocket.”
Yesterday I noticed a hummingbird hovering about the flower pots on our porch. I hurried to get my point and shoot camera and shot video, through a window as usual and it was getting a little late in the evening too, so light was low.
Can I blame the bird for always looking like a blur—or not? Anyway, the video looks similar to others I’ve managed to capture in years past, except this one was the closest I’ve ever gotten to one. I tried messing with the clip using my video editing software, but I ended up believing it best to leave it mostly unmessed around with.
On the other hand, the one I got about 6 years ago was pretty fair for an amateur backyard birder. Same camera, same software although I was closer to the birds and I’m pretty sure I was sitting outside and very patient. They were very interested in our little feeder.
I think the hummingbirds we’ve seen are ruby-throated species partly because that’s the most common in Iowa. Typically, I think it’s just the males who have ruby-colored throats; our visitor didn’t.
I guess the usual way to attract hummingbirds is with a feeder but other people say there are other reasons hummingbirds visit us. More common to the indigenous peoples, they may be thought of as the spirits of those who recently died and are visiting those they were close to.
I don’t remember the movie “The Curious Case of Benjamin Button” so well but I’ve glanced briefly at web articles which connect it with hummingbirds, which has something to do with their ability to fly backwards or in a figure 8, maybe connecting that with reverse aging or infinity. Other symbolic connections are with joy, healing, and partnership. There are so many connections they seem to blur together—sort of like the bird itself as it hovers and flits from flower to flower.
I think this hummingbird just really liked Sena’s flowers.
I listened to the Rounding@Iowa podcast “End-of-Life Doulas” twice because I’m at that difficult age when I think about my personal death. I don’t think about it at great length, mind you, but when I think about it, I feel afraid. Early mornings tend to be the time I wonder how much time now until…?
There was the usual podcast format, Dr. Gerry Clancy interviews Mary Kay Kusner, who is certified death doula to get the overview and details about what death doulas are all about.
I listened to the podcast in the late afternoon and discussed it only briefly with Sena. I felt out of sorts for a few hours afterward. I was in a funk until later in the evening when my thoughts almost abruptly switched to something funny. It was about a topic I’m thinking of for another blog post which has a humorous angle to it. I even chuckled a little out loud. I didn’t force that line of thought—it just happened.
But I know why it happened.
I didn’t know what a doula was until I listened to the podcast. Because I’m a writer by inclination, I looked for the original definition, which is a female servant who helps women with birthing. That didn’t enlighten me much, obviously; I can’t remember the last time I was pregnant (see what I did there?). An end of life-or-death doula helps people come to terms with impending death, death when it happens, and with whatever comes up after death has happened.
The title of this post comes from the Mary Kay Kusner’s short anecdote near the end of the podcast. Early in her career as a chaplain, she met with a 4-year-old child in the oncology unit who had a terminal illness, evidently death was coming and asked her, “How will I get to heaven?” They talked about it and the next thing the child said was, “So it’s like another dimension?” which Kusner evidently validated in some way. It’s a really cute story.
Anyway, there was a thread running through the podcast which pointed to what is apparently an ongoing psychological disconnect medical professionals have about death because we’re so focused on cure. It’s disappointing, but there you go. Death doulas are around to fill the role of talking calmly and matter-of-factly about it with patients and families.
There are some nuts and bolts about the profession, some of which I get and others which I scratch my head about. There are a couple of doula organizations in Iowa City which Kusner mentions: Community Death Doulas and Death Collective Eastern Iowa. Mary Kay Kusner is certified as a death doula via online training through INELDA.
Interestingly some people do not believe that this is a profession which can be certified, at least without some practical clinical experience. There’s a web site in which the question-and-answer section is longer than the article itself about this. The author recommends specific courses.
Death doulas are not covered by health insurance, so the practitioners arrange for payment, often through a sliding scale hourly fee. Part of the reason for the training of and demand for death doulas is that hospice nurses have heavy caseloads.
This reminds me of the hospice where my younger brother died after his battle with cancer. He was in his forties. Before he entered hospice, I had to be one of his doctors on the medical psychiatry inpatient unit after he accidentally overdosed on his pain medication.
When my brother was in hospice, I sat at his bedside. Most of the time, he was delirious. I watched and listened as one of the hospice workers as he asked him whether he was entering the dying process. He used those words. My brother was just as delirious as he was when he had to be admitted to the medical-psychiatry unit. I don’t know how much he heard.
I sat at his bedside, determined to hold some kind of death watch vigil. This was interrupted, ironically, by some friends of his who visited. They stood opposite the bed so that I had to look at them instead—and to listen as they told me stories about how close they’d been to him and how much they loved him.
By the time they were finished and I turned back to my brother, he was gone. It took me a little while to figure out I had not missed anything I really needed.
So, I think death doulas could be vital in building a bridge between those who are dying and those who need to connect with them. That’s the main thing.
I caught the Big Mo Pod Show today, “Music of the People” and of course, I listened to his Friday Blues show last night.
Big Mo is a bottomless pit of blues music knowledge (as well as other genres) and that takes me back to my wasted youth when I had a short conversation with one of my former bosses when I worked for Wallace Holland Kastler Schmitz & Co., a consulting engineer firm in Mason City, Iowa.
Ages ago, Ralph Wallace and I got into a short conversation one day about blues music, believe it or not. I can’t recall what actually got that short chat started but it was kind of surreal. He asked me about what I liked about the blues and I brought him up short by telling him I didn’t know anything about it.
I think Ralph thought I would know about the blues just because I was black. I didn’t. He even tried to prompt me by asking about different kinds of blues music, for example 12 bar blues and so on. I’ll never forget his facial expression when he realized I barely knew it existed. He looked puzzled and incredulous. He was a white man and knew more about it than I did. I think it stunned him that a black guy was completely ignorant of the blues.
I could dismiss the interaction simply as a mild form of racism, but I think it was more complicated than that. He was the boss of the company who gave me my very first real job but really didn’t know anything about my background. I was the child of a black man and white woman and my father left home when I was just a little kid. I went to an all-white church. I went to all-white schools, that is, until I was persuaded by a white woman and the black pastor and professor of religion and philosophy to enter Huston-Tillotson College (now Huston-Tillotson University), one of the HBCUs in America located in Austin, Texas. I first heard gospel music there and it raised the hair up on the back of my neck.
It’s a little ironic but I also think of John Heim (aka Big Mo) as another white man who knows more than I’ll ever know about the blues. And I’ve been learning from him for years, which is great.
So, the point is that the theme of the Big Mo Pod Show today is “Music of the People.” The blues is music for all people and the songs can have broad appeal.
One example is the song “Artificial” by Walter Trout. It’s a modern rant against the many synthetic artifacts in modern society and that includes something I rail against—Artificial Intelligence (AI). I can relate to it.
One song that didn’t make it to the list of 5 on the pod show but which was on the blues show last night was “Room on the Porch” by Taj Mahal and Keb’ Mo’ (featuring Ruby Amanfu). I got a surreal feeling about it because it’s about being openly welcoming to everyone. I hear a note of irony in it related to the current conflicts in America and around the world which highlight the opposite of openness and welcome. They’re not new.
On the other hand, I don’t think either Taj Mahal or Keb’ Mo’ intended for the song to be ironic. Maybe I just hear it because of all the background noise that has to be called reality because that’s what’s out there.
What if they’re not being ironic? What if they believe it and they’re trying to say there’s a good reason we should think of the blues as the music of the people—all the people? Where could we go from there?
Big Mo said it last night, “The blues can heal you, if you let it.”
As the month of May Mental Health Awareness draws to a close, I reflect a little on the Make It OK calendar items that are salient for me: 3 things I’ve done that I’m most proud of and 3 reasons I’m hopeful for the future. I’ll keep it short.
One thing I’m most proud of is being the first one in my family to go to college. The biggest accomplishment was going to medical school at The University of Iowa in 1988. That was also the year Michael Jackson’s pop hit “Man in the Mirror” was released. That’s sort of how I felt about what I was doing that year—making a big change.
The more I reflect on this the more I realize the other thing I’m most proud of was getting a degree from Iowa State University in 1985. That paved the way for the path to becoming a doctor.
This process seems to work backwards because probably the first thing I’m proudest of is making a change even earlier in my life to land a job with a Mason City, Iowa consulting engineer firm, Wallace Holland, Kastler Schmitz & Co. That came before college and they’re all like stepping stones on the path of achievement. I think I started at the minimum wage back then, which was about $2.00/hr. I was an emancipated minor and couldn’t afford an apartment so I lived at the YMCA. It was a cramped sleeping room with no kitchen, a communal bathroom/shower, and a snack vending machine from which I got a worm infested candy bar. There were strict rules about what you could keep in your room—which somehow didn’t prevent one guy from building a motorcycle in his. Now this is getting too long.
In order to move on expeditiously with the mental health awareness calendar items, I’m going to cheat on the 3 reasons I’m hopeful for the future because they involve what is most important to a teacher. That’s what I was. I was so proud of the many medical students and residents I had the honor to teach. There were a lot more than 3 reasons to be hopeful for the future. I used to take group pictures of them and me at the end of each rotation through the consultation psychiatry service. We got a kick out of that because the only way I could do it was by using my old iPad that had a fun remote way to trigger the snapshot. I leaned the iPad up against something on a table. We all gathered as a group at the other end of the room. We posed, I raised my hand and counted to three, then closed my hand into a fist. That was our cue to smile. The shutter clicked.
Every time we did that, I was proud. Wherever they are, I hope they know how proud I am of them.
I just read Dr. George Dawson’s excellent blog post on supportive psychotherapy (“Supportive Psychotherapy—The Clinical Language of Psychiatry.” If you’re looking for an erudite and humanistic explanation of supportive psychotherapy, I think you’re unlikely to find anything superior to Dr. Dawson’s essay.
Now, about my take on “supportive” psychotherapy—there’s a reason why the word supportive is wrapped in quotes. It’s because I have a sort of tongue in cheek anecdote about it based on my experience with a staff neurologist in the hospital. It was long enough ago that I’m not sure what level of training I was in exactly. I was either a senior medical student or a resident doing a rotation on an inpatient neurology unit.
Dr. X was staffing the neurology inpatient service and I happened to overhear a brief conversation he had with the psychiatry consultants about what approach to adopt with a patient who he believed had a gait problem due to a psychological conflict. He wanted a psychological approach, preferring something on the psychodynamic side. I remember the psychiatric consultant said flatly, “We’re pretty biological.” I can’t remember what their recommendation was, but he disagreed. Later in the day, Dr. X gathered all of the trainees and we rounded on the patient in his hospital room.
We all crowded into the room with the patient, who had a severe problem walking due to what seemed to be unexplained hemiparesis. This is where the “supportive” element of Dr. X’s approach to psychological treatment came in.
Whether due to a deformity or past injury (I can’t recall which), Dr. X walked with a pronounced limp. He asked the patient if he would be willing to try walking vigorously with him across his room. Dr. X promised to assist him up and made it very clear that, despite his own limp, he was going to walk with the patient as normally as possible, together using both their legs.
The patient was very hesitant. Dr. X offered a lot of reassurance and encouragement—and then hoisted him up out of bed and marched with him across the room, ensuring that the only way this could happen was if he used both legs. The scene was comical, Dr. X limping but strongly moving in one direction while hauling the patient along with him.
The patient did it—twice and with increasing speed while obviously using both legs, never collapsing to the floor while Dr. X effusively praised him. He looked embarrassed and also seemed genuinely grateful for this miraculous cure. I was impressed.
I’m calling this a form of supportive psychotherapy partly in jest, but also to make a point about what support can mean, both literally and figuratively speaking, under certain circumstances according to how differently trained health care professionals might define psychiatric help.
Later in my career as a psychiatric consultant in the general hospital, I often found that many medical generalists and specialists preferred patients with these kinds of afflictions be transferred to psychiatric wards.
I don’t recall Dr. X ever suggesting that.
The personal identities of both doctor and patient were de-identified.
We just got a couple of books by Ray Bradbury, and I’m pretty excited. Some of the stories I recognize, but there will be some, perhaps many, that will be new to me.
I learned a new slang word from Houston White, the guy who makes that specialty coffee in Minneapolis I blogged about yesterday: Brown Sugar Banana (I’m not a fan, but I admire him just the same). The word is “dope.” That used to be an insult or an illicit drug when I was growing up. Now it means “very good.”
I guess writing, at least for me, is dope.
The further I get in time away from the day I retired from practicing consultation psychiatry, the more I reflect about how I became a psychiatrist. I’m a first-generation doctor in my family, so what follows is one way to write about it.
What has helped me get through life was this writing habit along with a sense of humor. When I was little, I wrote short stories for my mother. I was the “number one son” in the words of my father, which meant only that I was the first born. My younger brother came second only in order of birth. He was the track star. I was the paperboy. Our parents separated early on. Sena and I have been married for 47 years.
I have been writing my whole life. I used a very old typewriter. I wrote poetry for a while, eons ago. Like many aspiring writers, I tried to sell them to publishers. The only publisher I remember ever responding sent me a hand-scrawled note on a small sheet of paper. He told this really short, nearly incoherent story about his son, who had apparently died shortly before. His son had a “tough road.” It wasn’t clear exactly how he died, but I remember wondering whether it was suicide. It was very sad.
In the 1970s, while I was a student at one of the Historically Black Colleges and Universities (Huston-Tillotson College, now a university) in Austin, Texas, I submitted a poem to the school’s annual contest and for entry into the college’s collection, called Habari Gabani (which means “what’s going on” in Swahili). It was rejected. Years later, I finally was able to track down a digital copy of Habari Gani.
Habari Gani from Huston-Tillotson College
Eventually, thank goodness for everyone’s sake, I gave up writing poetry. It was as bad as Vogon poetry. You’ll have to read Douglas Adam’s book “A Hitchhiker’s Guide to the Galaxy,” for background on that. The Vogons were extraterrestrials who destroyed Earth in order to build an intergalactic bypass for a hyperspace expressway. Vogon poetry is frightfully bad; it’s the waterboarding torture of literature.
I wrote a short Halloween story for my hometown newspaper contest once. It got honorable mention, but I can’t recall what it was about, thank goodness.
I wrote a feature story in a journalism class taught by a nice old guy who made a long speech to the class about the unfortunate tendency for young writers to use flowery, polysyllabic words in their prose. He made it clear that journalists shouldn’t write like that. Although I didn’t consciously do the opposite to annoy him, I did it anyway. I even tossed the word “Brobdingnagian” in it, which might have referred to some high bluffs somewhere in Iowa. Despite being infested with Vogonisms, my teacher tolerated it, sparing my feelings. I must have passed the course although how I did it remains a mystery.
I wrote and co-edited a book with the chairman of the University of Iowa Healthcare Dept of Psychiatry, Dr. Robert G. Robinson, MD. It was “Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry”. There were several contributors. Many of them were my colleagues. It was published in 2010, and prior to that, I’d written an unpublished manual that I wrote for the residents.
There wasn’t any humor in either book, because they were supposed to be evidence of scholarly productivity from a clinical track academic psychiatrist. But I used humor and non-scientific verbiage in my lectures, albeit sparingly. I remember one visiting scientist remarked after one of my Grand Rounds presentations, “You are so—poetic” and I detected a faint disparaging note in his tone…probably a reaction to a latent Vogonism. It’s not impossible to monkey-wrench those into a PowerPoint slide or two.
I used to write a former blog called The Practical Psychosomaticist, later changed to The Practical CL Psychiatrist when The Academy of Psychosomatic Medicine changed their name back to The Academy of Consult-Liaison Psychiatry back in 2017. I wrote The Practical CL Psychiatrist for a little over 7 years. I stopped, but then missed blogging so much I went back to it in 2019 after only 8 months. I guess I was in withdrawal from writing.
That’s because writing is dope.
Go Retire Psychiatrist 