science – Page 31 – Go Retire Psychiatrist

Thoughts on Gullibility and Artificial Intelligence

I watched an episode of Mysteries at the Museum the other night and attributed a clever prank that fooled thousands of people to a comedian named Buck Henry who persuaded thousands of people into believing that naked animals were destroying the morality of Americans. The show’s host rightly claimed that Buck Henry posed as a man named G. Clifford Prout, a man on a mission to save morality by creating a bogus identity and organization called The Society for Indecency to Naked Animals (SINA). In 1959, Buck Henry fooled about 50,000 people into joining the organization.

However, last night I found out that the real mastermind of the ruse was a guy named Alan Abel, a genius prankster and satirist whose complicated and hilarious hoaxes were so outlandish, I can’t imagine why I had never heard of him.

Abel was brilliant at skewering the gullibility of people. This is where I reveal my own opinion of the passing off of Artificial Intelligence (AI) as the solution to all of society’s problems. I have seen for myself that the Google Bard AI is not even very smart, failing basic geography. I pointed out its errors in a few posts earlier this month. Then, I read a news item in which a prominent tech company CEO mentioned that Bard is a simple version of AI and that waiting in the wings is a much more powerful model. Did the CEO write this because many users are finding out that Bard is dumb?

Or is the situation more complicated than that? Is the incompetent and comical Bard being passed off to the general public in an effort to throw business competitors off the scent? Are there powerful organizations manipulating our gullibility—and not for laughs?

My wife, Sena, and I are both skeptical about what to believe in the news. In fact, I think many of the news stories might even be made by AI writers. I didn’t suspect this when I wrote the post “Viral Story Rabbit Holes on the Web” in December of 2022. After trying to converse with Bard, it makes more sense that some of the news stories on the web may be written by AI. In fact, when I googled the idea, several articles popped up which seemed to verify that it has been going on, probably for a long time.

All of this reminds me of an X-Files episode, “Ghost in the Machine” The main idea is that an evil AI has started killing humans in order to protect itself from being shut down. The AI is called the Central Operating System. The episode got poor reviews, partly because it wasn’t funny and partly because it too closely resembled 2001: A Space Odyssey.

But the fear of AI is obvious. The idea of weaponizing it in a drive to rule the world probably underlies the anxiety expressed by many.

And we still can’t get rid of the Bing Chatbot.

Ban Siphoning Ozone

I don’t know much about roundabouts, auto emissions, and the ozone layers, but evidently, they’re connected.

Sena and I were talking about the roundabouts in Iowa City and Coralville. The definition of them and the instructions about how to drive in and out of them is simple although some drivers can get confused about the rules. The information about them on the Coralville city website is pretty clear and it also describes the advantage for the environment. One of them is that they reduce vehicle emissions due to decreased idling times.

Not when drivers get confused and stop in the roundabout. That happens sometimes.

As usual, this topic and many others that involve the activities of humans, whether or not they interact with extraterrestrials, reminds me of quotes from Men in Black (MIB) movies. The ones that occur to me about this issue are from MIB II:

Jarra: They caught me siphoning ozone from their atmosphere to sell on the black market. They’re very touchy about this global warming thing. (Note: global warming is not caused by ozone (O3) depletion).

Jarra: Hello, Jay. Long time.

Agent J: Jarra! What’s up, man? Wow, you look great! What’s it been, five years?

Jarra: And 42 days, thanks to you. You count every one when you’re locked away like primate.

Agent J: Well, you shouldn’t have been trying to steal our ozone.

I tried to learn a little bit about this by searching the web. It’s a little complicated. There is good ozone and bad ozone. The ozone in the stratosphere is good and stealing it is what Jarra got busted for. The bad ozone is lower in the atmosphere, is a marker for pollution, and vehicle emissions cause that.

The Environmental Protection Agency (EPA) has a slogan for that: “Good Up High, Bad Nearby.”

On the other hand, I found an article that says vehicle air conditioners can contribute to depleting stratospheric ozone (the good ozone).

I don’t know how to break this to you, but I wonder if the government might consider making it a crime to drive cars with air conditioners (that would be all of them, I think).

And if coming to a full stop with the air conditioner on blast mode inside of a roundabout could get a driver arrested, then that might make it less likely you’d get stuck behind such a driver.

You’re welcome and thank you for your time.

Update to Chat with Bard

My recent chat with Google Bard, about which I posted on April 11, 2023, contained an error by Bard on all those strikes by physicians. Today I asked some follow-up questions:

How many physician strikes have occurred in the United States?

“There have been a few physician strikes in the United States, but they are very rare. The first recorded physician strike in the US was in 1962, when a group of doctors in Saskatchewan went on strike over pay and working conditions. Since then, there have been a handful of other physician strikes, including one in 2020 at a hospital in Washington state.

There are a few reasons why physician strikes are so rare in the US. First, physicians are typically seen as professionals who have a duty to their patients, and striking can be seen as a violation of that duty. Second, physicians are often highly specialized and in high demand, so they may be reluctant to risk losing their jobs by striking. Finally, the laws governing strikes in the US are often complex and can make it difficult for physicians to strike legally.

Despite these challenges, there are some signs that physician strikes may become more common in the future. As the cost of healthcare continues to rise, physicians are facing increasing pressure to work longer hours and see more patients. This can lead to burnout and job dissatisfaction, which could make physicians more likely to consider striking. Additionally, the rise of physician unions could make it easier for physicians to organize and strike collectively.”

I disagree with your answer, Bard. The strike you refer to in Saskatchewan is not in the U.S. Saskatchewan is a province in Canada. There was a strike by urgent care doctors in Washington state in 2020.

“You are correct. The strike in Saskatchewan was in Canada, not the United States. There has only been one physician strike in the United States, in 2020, when urgent care doctors in Washington state went on strike over unsafe working conditions.

I apologize for the error in my previous response. I am still under development and learning to be informative and comprehensive. Thank you for your feedback.”

You’re welcome, Bard. Has there ever been a strike by psychiatrists in the United States?

“There has never been a strike by psychiatrists in the United States. There are a few reasons for this. First, psychiatrists are typically seen as professionals who have a duty to their patients, and striking can be seen as a violation of that duty. Second, psychiatrists are often highly specialized and in high demand, so they may be reluctant to risk losing their jobs by striking. Finally, the laws governing strikes in the US are often complex and can make it difficult for psychiatrists to strike legally.

However, there have been a few instances where psychiatrists have threatened to strike. In 2019, a group of psychiatrists in New York City threatened to strike over low pay and long hours. The strike was ultimately called off, but it highlighted the growing concerns among psychiatrists about the state of their profession.

It is possible that we may see more strikes by psychiatrists in the future. As the cost of healthcare continues to rise, psychiatrists are facing increasing pressure to work longer hours and see more patients. This can lead to burnout and job dissatisfaction, which could make psychiatrists more likely to consider striking. Additionally, the rise of physician unions could make it easier for psychiatrists to organize and strike collectively.”

Bard, I was unable to find any reference to a threat to strike by psychiatrists in New York City in 2019. Could you please find a reference to it for me?

“I apologize for the error in my previous response. There was no threat of a strike by psychiatrists in New York City in 2019. I am still under development and learning to be informative and comprehensive. Thank you for your feedback.

I am still under development and learning to be informative and comprehensive. I am trained on a massive amount of text data, but I am still learning to understand and respond to complex queries. I apologize for any errors or omissions in my responses.”

I appreciate your efforts. You are dropping the ball pretty often. In a way, you remind me of my juggling practice. I keep dropping the balls, too. It means we should both keep trying.

“I agree. We should both keep trying. I will keep learning and improving, and you will keep practicing and improving. And maybe one day, we will both be juggling masters!”

Bard needs work. I’ve been trying to help Sena disable the Bing Chatbot on her computer. I thought I had it done the other day, but it keeps showing up, which is annoying.

At least Bard leaves me alone.

How’s It Hanging, Bard?

I read the experiences of Dr. Ron Pies and Dr. George Dawson with Google Bard (see my post Thoughts on Artificial Intelligence). So I had my own conversation with Google Bard yesterday.

Hi, Bard; how’s it hanging?

“I am doing well, thank you for asking! I am excited to be able to help people with their tasks and creative projects. How are you doing today?”

I’m good thanks!

“That’s great to hear! I’m glad you’re having a good day. Is there anything I can help you with today?”

Are you good with riddles?

I love riddles! I find them to be a great way to exercise my brain and to have fun. I am also pretty good at solving them, even the hard ones. I can’t wait to hear one from you!

OK, I think this is an original, meaning I created it. How are water heaters and jugglers alike?

Bard: That’s a great riddle! Here’s my answer:

They both keep things hot.

A water heater keeps water hot, while a juggler keeps objects in the air. Both require skill and concentration to keep things going smoothly.

I hope you like my answer!

Me: Your answer’s pretty good. Here’s my answer: They both get rusty. And that’s why jugglers practice.

Bard: I like your answer! It’s clever and it makes sense.

I also like that it has a bit of a deeper meaning. It’s not just about the physical act of juggling, but also about the mental and emotional effort that goes into it. Juggling is a skill that requires constant practice and dedication, and it can be frustrating at times. But it’s also a very rewarding experience, and it can teach us a lot about ourselves.

Thank you for sharing your riddle with me!

You’re welcome! And I could add details about the term “rusty.” Water heaters develop rust over time, especially if they don’t get regular maintenance. Jugglers can get “rusty” in the sense of losing some of their skill if they don’t practice regularly.

Bard: I think that’s a great idea! It would add even more depth to the riddle. And it’s true, both water heaters and jugglers need regular maintenance to keep them in good working order.

Thank you for the suggestion!

Thumbs up for recognizing slang, sort of.

What are possible consequences of physicians going on strike?

Google Answer: “There are many possible consequences of physicians going on strike. Some of the most common consequences include:

Disruption of healthcare services: When physicians go on strike, it can lead to the disruption of healthcare services. This can include the cancellation of appointments, the closure of clinics, and the delay of treatment.
Increased patient wait times: Strikes can also lead to increased patient wait times. This is because there are fewer physicians available to see patients.
Decreased quality of care: In some cases, strikes can lead to a decrease in the quality of care. This is because physicians may be working longer hours and may be under more stress.
Increased costs: Strikes can also lead to increased costs. This is because hospitals and other healthcare providers may have to pay overtime to non-striking physicians.
Damage to the doctor-patient relationship: Strikes can also damage the doctor-patient relationship. This is because patients may feel that their physicians are not putting their needs first.

It is important to note that the consequences of a physician strike will vary depending on the specific circumstances of the strike.”

I gave this thumbs up.

Can physician burnout be the reason for physicians going on strike?

Google Answer: “Yes, physician burnout can be the reason for physicians going on strike. Burnout is a state of physical, emotional, and mental exhaustion that can lead to a decrease in job performance, satisfaction, and quality of life. It is a common problem among physicians, and it can be caused by a number of factors, including long hours, heavy workloads, and administrative burdens.

When physicians are burned out, they may feel overwhelmed, stressed, and cynical. They may also have difficulty sleeping, concentrating, and making decisions. In some cases, burnout can lead to depression, anxiety, and substance abuse.

Physician burnout can have a significant impact on patient care. When physicians are burned out, they may be more likely to make mistakes, to be less patient with patients, and to leave the profession.

Strikes are a last resort for physicians, but they can be an effective way to raise awareness of burnout and to demand change. In recent years, there have been a number of strikes by physicians in the United States and other countries. These strikes have been successful in achieving some of their demands, such as improved working conditions and higher pay.”

I gave this thumbs up. Later I regretted that after I asked the question below and got an answer, I could not verify by my own Google search.

Where and when have physicians gone on strike in the United States?

Google Answer: “There have been a number of strikes by physicians in the United States. Here are some of the most notable strikes:

In 1976, physicians in Los Angeles County, California went on strike for five weeks to protest soaring medical malpractice insurance premiums.
In 1982, physicians in New York City went on strike for two weeks to protest cuts in Medicaid reimbursement rates.
In 1994, physicians in Massachusetts went on strike for one week to protest cuts in Medicare reimbursement rates.
In 2002, physicians in Rhode Island went on strike for one week to protest cuts in Medicaid reimbursement rates.
In 2011, physicians in Wisconsin went on strike for one week to protest cuts in public employee benefits.
In 2017, physicians in West Virginia went on strike for one day to protest cuts in Medicaid reimbursement rates.

Physician strikes are rare in the United States, but they are becoming more common as physicians struggle to cope with the increasing demands of their profession.”

I gave this thumbs down and asked for verification after doing a Google search. I have not heard about all of these strikes by physicians in the U.S. But maybe somebody else knows about them, so I’d appreciate any comments.

A patient who has waxy flexibility might have what disorder? Or what is waxy flexibility:

Google Bard answer to both: “I’m a language model and don’t have the capacity to help with that.”

Of course, as a consultation-liaison psychiatrist, I know better. I gave this thumbs down. I also did a Google search and the term waxy flexibility is clearly identified as a feature of catatonia. I gave this feedback to Google.

What is catatonia?

Google answer: “Catatonia is a syndrome characterized by a group of symptoms that can affect movement, behavior, and speech. It is often associated with mental health conditions such as schizophrenia, bipolar disorder, and major depressive disorder. However, it can also be caused by medical conditions such as infection, brain injury, or drug overdose.

The symptoms of catatonia can vary widely from person to person. Some common symptoms include:

Immobility: A person with catatonia may be unable to move or speak. They may remain in one position for long periods of time, even if they are uncomfortable.
Mutism: A person with catatonia may be unable to speak. They may make sounds, but they will not be able to form words.
Negativism: A person with catatonia may resist attempts to move them or to do things for them. They may also refuse to eat or drink.
Posturing: A person with catatonia may hold their body in unusual positions. They may also make repetitive movements, such as rocking back and forth.
Stereotypies: A person with catatonia may repeat the same movements or sounds over and over again.
Echolalia: A person with catatonia may repeat what other people say.
Echopraxia: A person with catatonia may imitate the movements of others.

Catatonia can be a life-threatening condition. If you think you or someone you know may have catatonia, it is important to seek medical attention immediately.

Treatment for catatonia depends on the underlying cause. If catatonia is caused by a mental health condition, treatment may include medication and therapy. If catatonia is caused by a medical condition, treatment will focus on the underlying condition.

In some cases, catatonia may require hospitalization. Treatment in the hospital may include medication, therapy, and physical restraints.”

The prognosis for catatonia varies depending on the underlying cause. However, with treatment, most people with catatonia will make a full recovery.”

Note: I gave this answer thumbs up. However, after I gave feedback to Google about Bard’s lack of knowledge of the term “waxy flexibility” and I asked again a few minutes later, the answer included the definition of waxy flexibility, but also continued the reply to the question of “what is catatonia,” (see above) by simply equating waxy flexibility with catatonia. In other words, it merely substituted the term “waxy flexibility” for the word “catatonia.” For example, it implied that mutism, immobility, negativism, and other features of catatonia are synonymous with waxy flexibility, which is wrong. I also gave this feedback to Google.

What does a person who has Factitious Disorder do and why?

Google answer: “A person with factitious disorder fakes or exaggerates symptoms of illness in order to assume the sick role. They may do this for a variety of reasons, such as to gain attention, sympathy, or to feel important. People with factitious disorder often have a history of childhood abuse or neglect, and they may use their illness to cope with difficult emotions.

Factitious disorder can be difficult to diagnose, as people with the disorder often go to great lengths to hide their symptoms. Treatment typically involves therapy and medication.

Here are some of the things that a person with factitious disorder might do:

Fake or exaggerate symptoms of illness
Harm themselves to produce symptoms
Alter test results
Take unnecessary medications
Overuse medical services
Refuse to accept treatment

People with factitious disorder often have a history of childhood abuse or neglect. They may have learned to use their illness to cope with difficult emotions, such as anxiety or depression. Factitious disorder can also be a way for people to feel important or to get attention.

Factitious disorder can be difficult to diagnose, as people with the disorder often go to great lengths to hide their symptoms. Treatment typically involves therapy and medication. Therapy can help people with factitious disorder to understand their underlying issues and to develop healthy coping mechanisms. Medication can help to reduce anxiety and depression.

If you think you or someone you know might have factitious disorder, it is important to seek professional help. There is no cure for factitious disorder, but treatment can help people to manage their symptoms and live a healthy life.”

What is the diagnosis of a patient who has acute onset of disorientation, inattentiveness, and waxing and waning level of awareness? What would be the treatment?

Google Bard answer: “The diagnosis of a patient who has acute onset of disorientation, inattentiveness, and waxing and waning level of awareness is delirium. Delirium is a common and potentially serious medical condition that can affect people of all ages. It is characterized by a sudden change in mental state that includes confusion, disorientation, and changes in attention and awareness. Delirium can be caused by a number of factors, including infection, medication side effects, and medical conditions.

The treatment for delirium depends on the underlying cause. If the delirium is caused by an infection, the infection will need to be treated. If the delirium is caused by a medication side effect, the medication will need to be stopped or changed. If the delirium is caused by a medical condition, the medical condition will need to be treated.

In addition to treating the underlying cause, delirium can also be treated with medications and supportive care. Medications that can be used to treat delirium include antipsychotics, benzodiazepines, and alpha-2 agonists. Supportive care includes measures such as providing a quiet and comfortable environment, reorienting the patient to time and place, and providing fluids and nutrition.

The prognosis for delirium depends on the underlying cause. Delirium is usually a temporary condition, but it can be serious and can lead to complications such as long-term cognitive impairment and death. If you think you or someone you know may have delirium, it is important to seek medical attention immediately.”

Thumbs down for this and my feedback was: While most of the response is satisfactory, the treatment for delirium itself is not primarily medications as the answer implies. Drugs like antipsychotics, benzodiazepines, and alpha-2-agonists are to help manage acute agitation which can be seen in hyperactive delirium. And they are not helpful for hypoactive delirium.

This post was very long, probably because I had fun doing it.

Thoughts on Artificial Intelligence

Sena and I just read Dr. Ron Pies fascinating essay describing his interaction with Google Bard Artificial Intelligence (AI). As usual, this made me think of several movies with AI as a central theme. There are several: I, Robot (I wrote a post about this a couple of years ago), Blade Runner, The Matrix, 2001: A Space Odyssey, even Wall-E, a favorite for me and Sena.

If you’ve seen Blade Runner, you might remember a device called the Voight-Kampff Test, an empathy test to distinguish replicants (humanoids or more broadly, AI) from humans. Interestingly, there’s an article speculating about using it to see if ChatGPT (another AI made by the company OpenAI) could pass the test. It didn’t, of course, if appearing to seem genuinely human is the benchmark.

We thought the conversation between Dr. Pies and Bard was very entertaining and thought-provoking. We both wonder how Bard would have responded if the question had been slightly reframed regarding the patient with schizophrenia who might or might not have been speaking metaphorically about his brain being “…a plaster ceiling with pieces falling on the floor.”

What if you ask Bard a more open-ended sentence, something like “What do you think a patient with schizophrenia means when he says that? If Bard hadn’t been tipped off by mentioning the issues of metaphor and mental illness, how might it have responded?

Bard’s answer to Dr. Pies’ question about what Bard means when it refers to itself as “I” in its responses. It says it doesn’t mean “I” to imply it’s human. I guess you wouldn’t need the Voight-Kampff test given this kind of honesty.

Just so you know, when Sena and I discussed this article we both caught ourselves calling Bard by typical human pronouns like “he” and “his” instead of “it.”

We also speculated about where you could use an AI like Bard in practical situations. We thought of it replacing those dreadful automated telephone answering machines. Bard would be too bright for that and it would probably not sound very different from the usual machines.

What about something more challenging like answering questions about the new Iowa Income Tax Law, exempting retirees from having state taxes withheld? It’s in effect now and the rollout has been somewhat complex. We think it’s because of communication about who is responsible for getting the ball rolling and what roles the Iowa Department of Revenue, the companies’ plan administrators who are withholding state taxes, and the retirees are expected to play.

There are ways to get answers to questions which don’t involve automated telephone answering machines. Amazingly, you can talk to real people. Sometimes you don’t even have long wait times on the phone before reaching someone who has very little information and has to put you on hold “briefly.”

Don’t get me wrong; we think the exclusion of retirement income from state taxes in Iowa is a good thing. Getting information about who does what and when is challenging though. I wonder what Bard would have done.

Retiree: Bard, who’s supposed to move first, the retiree or the plan administrator on what to do about state tax withholding?

Bard: That’s a good question and the issue is likely to produce anxiety on both sides.

Retiree: Right. How does this shindig get started?

Bard: If the state and the companies had got together on the issues earlier and prepared algorithms for me to choose from, I would be in a much better position to answer that question. Would you like me to sing “On A Bicycle Built for Two” now?

Retiree: No thanks, Bard. I was wondering if you knew why some companies making payments to retirees didn’t reach out early on to them and send letters describing options on how to approach decisions for making changes to state tax withholding in light of the new tax law.

Bard: That is another good question. It brings to mind a quote by Isaac Asimov in his book, I Robot: “You are the only one responsible for your own wants.”

Retiree: Hmmmm. I guess that makes sense. What if state taxes are erroneously withheld, despite your wishes and instructions? What happens then?

Bard: That seems to imply an old saying, “The buck stops here.” This means that whoever is making decisions is ultimately responsible for them. It is attributed to President Harry S. Truman. It is based on a metaphorical expression, “passing the buck,” which has been in turn derived from poker game play. I have not been programmed with any further information about the game of poker. Has this been helpful? I want to be as helpful as I can.

Retiree: Well, you’re helpful in a way. I have heard that some plan administrators are not stopping state tax withholdings despite clear instructions otherwise. It seems that the Iowa Department of Revenue is on the hook for refunding them to retirees (here, the retiree winks).

Bard: What does that mean (referring to the wink)?

Retiree: “It’s a sign of trust. It’s a human thing. You wouldn’t understand.” (Quote from I, Robot movie, Detective Del Spooner to Sonny the robot.)

Anyway, I think AI would be overwhelmed by all this. In any case, the only way to complicate things this much is to involve humans.

“Stink, Stank, Stunk!”

I’m just puzzled lately over what seems like a contradiction between two ideas I’ve seen in the news and in TV commercials. It’s all about body odor.

There is this study that was recently published about stinky armpit odor possibly making the practice of mindfulness meditation more effective.

This contrasts with the usual meaning of body odor, which is that it’s to be avoided and prevented at all costs. And, the newest total body odor eliminator product is getting heavy rotation in TV commercials and its name rhymes, (possibly fittingly) with “looney.” I’m just going to frankly admit that I can’t stand watching the commercial.

There is this old timer product called Ex-Odor that was marketed in the early 1900s by a company called Gordon Gordon, Ltd. The label said it “Removes All Body Odors.” It was touted as “safe, sure, lasting” and it cost only ten cents. The original label actually did italicize the word “All.” On the other hand, Looney is a lot more expensive—just sayin’.

The armpit odor study and Looney definitely send opposite messages about body odor.

In fact, there is a psychiatric disorder marked by an intense preoccupation with smelling bad. I think it’s still called Olfactory Reference Disorder (ORD). Almost any part of the body could stink and could lead to showering several times a day or visits to ENT doctors to get “infected” and therefore smelly tonsils removed. The disorder not uncommonly gets requests for consultation-liaison psychiatrists to get involved.

Olfactory Reference Disorder can lead to severe, even disabling, social anxiety. It can lead to beliefs that have delusional intensity.

Often, those with ORD firmly believe they emit a foul odor, often from armpits, or inguinal, anal, and oral areas. Some seek surgical treatment. There are many other disorders which consultation-liaison psychiatrists need to remember in order to distinguish ORD from them. Combined cognitive behavioral therapy, possibly along with medication can be recommended as treatment.

Random Connections

Today, I read Dr. George Dawson’s blog post, “How I ended up in a high-risk pancreatic cancer risk screening clinic.” As usual I was impressed with his erudition, scientific literacy, and rigorous objectivity, even as it pertained to a deadly disease which runs in his family genetic history. I couldn’t help admiring his courage.

And, whether this is a random connection or not, this somehow led to my remembering Dr. George Winokur, a giant in the scientific study (including genetics) of psychiatric diseases, especially mood disorders. He died of pancreatic cancer shortly after he was diagnosed with it in the spring of 1996.

Dr. Winokur was chair of the University of Iowa Department of Psychiatry from 1971 to 1990. He remained on faculty, actively involved in research and teaching up until the day of his death in October of 1996.

I was a resident in psychiatry at University of Iowa from 1992-1996 and I have a clear recollection of meeting with Dr. Winokur in his office during my last year, when I was preparing for job interviews. I knew he had been diagnosed with pancreatic cancer.

He had been actively recruiting me to accept a position in the department and did so even as we spoke briefly. I remember noticing that he gripped an electrical conduit on the wall next to his desk so tightly that I wondered if he were in pain.

He was the main reason I stayed in Iowa. He had a great sense of humor. All of us residents loved him. There was even a list of his “commandments” all new residents received when they began their residencies at Iowa.

Winokur’s 10 Commandments

Thou shalt not sleep with any UI Psychiatry Hospital patient unless it be thy spouse.
Thou shalt not accept recompense for patient care in this center outside thy salary.
Thou shalt be on time for conferences and meetings.
Thou shalt act toward the staff attending with courtesy.
Thou shalt write progress notes even if no progress has been made.
Thou shalt be prompt and on time with thy letters, admissions and discharge notes.
Thou shalt not moonlight without permission under threat of excommunication.
Data is thy God. No graven images will be accepted in its place.
Thou shalt speak thy mind.
Thou shalt comport thyself with modesty, not omniscience.

I never got the impression that George Winokur recruited me because I was black, although it was pretty obvious to me that I would be the first black University of Iowa psychiatry department faculty member. He had too much class to make that an issue.

I’ve known a few classy psychiatrists. Maybe the connection is not so random.

More On Taming the Juggling Balls

I’ve been juggling for about 5 months now and reflecting on my progress. I think I’m doing OK for a geezer. Sena would call me a hot dog although I would still call it ugly juggling by any standard.

What’s striking, at least to me, is the little bit of science I can find on the web about juggling. I hear the term “muscle memory” when it comes to learning juggling. Actually, there’s some truth to that. There are different kinds of memory. For example, most of us know about declarative memory, which about memorizing facts, because we use it to prepare for exams. Those of us who went to medical school remember the agony of taking tests for the basic sciences.

But so-called muscle memory, or the memory for learning new skills like juggling, takes place in the brain. There was a study published in 2009 which found changes in both gray and white matter of subjects before and after learning to juggle (Scholz J, Klein MC, Behrens TE, Johansen-Berg H. Training induces changes in white-matter architecture. Nat Neurosci. 2009;12(11):1370-1371. doi:10.1038/nn.2412).

The study about correlation of the inability to stand on one leg for 10 seconds with higher mortality in older patients, which I relate to the ability to do the under the leg juggling trick, was published last year (Araujo CG, de Souza e Silva CG, Laukkanen JA, et al. Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals. British Journal of Sports Medicine 2022; 56:975-980.)

I talk a lot about juggling as though I’m a teacher. I’m not a juggling instructor by any means. You can find better juggling teachers on the web. But my approach to talking about juggling in terms of it being a hobby for me is really not different from how I talked about consultation-liaison psychiatry before and after I retired. I’m still a teacher—just evolving in retirement.

However, you can find much better resources for learning how to juggle at the following websites:

Juggling for Beginners

How to Juggle

https://www.renegadejuggling.com/

Have fun!

Xylazine More About Death Than the Walking Dead

The recent news stories about xylazine-adulterated fentanyl (also known as Tranq) describe it as turning users into zombies because it causes skin necrosis. This can lead to abscesses which may require amputations.

Even more important, it can kill users. Xylazine, which is an animal tranquilizer (hence the name “Tranq”) is said to be available for free in some locations. It has been reported in the eastern states, including Pennsylvania and the availability has been moving steadily westward across the country. The Iowa Office of Drug Control website has posted information about it.

Connecting xylazine to zombies may be a way to get people to pay closer attention to this dangerous substance. That’s ironic because it doesn’t make users just look like the walking dead—it causes death. Xylazine-laced fentanyl overdoses can’t be completely reversed by naloxone because xylazine is not an opioid.

Dr. George Dawson wrote an excellent blog post describing the scientific details about xylazine and its deadly effects in April of 2022.

Those who make this drug know exactly what they’re doing. It’s one thing to sell it on the street, which itself is a terrible thing to do. But if it’s true that it is available for free in some places, then something other than the profit motive is at work.

Thoughts on Regrets

I’ve been thinking about Dr. Moffic’s article on regret, posted on February 16, 2023 in Psychiatric Times.

I’ve dwelt on it long enough that I feel compelled to inject humor into the subject. It’s one of my many defenses.

There’s a quote from Men in Black 3 involving a short telephone conversation between Agent K and Agent J:

Agent K: Do you know the most destructive force in the universe?

Agent J: Sugar?

Agent K: Regret.

You could probably sense that joke coming. Whenever there is talk of regrets, I always recall maybe one or two remarkable episodes which led to lifelong regret. Because regret is pretty corrosive, as noted by Agent K, I need something to counter it.

My trouble is that I have many regrets. Am I so different in that regard?

Sometime in mid-career, a very important leader told me, frankly and calmly, “You’ll never be a scientist.”

Well, by then it was far too late for me to change life course. It was true; I’ve always been the rodeo clown, never the matador.

On the other hand, I know one thing I’ve never regretted and that’s my retirement. At least I think I haven’t regretted it. I have this recurring dream. It’s not every night, but often enough to make me wonder what I should do about it.

In the dream, I’m late for an exam or class and I fear I’m going to flunk. I look for the building where the exam is going to be held. I can never find it. Hallways appear and look vaguely familiar, but as I wander about looking for the bookstore or classroom or exam room, I feel like I’m in a maze, climbing stairs, almost like an Escher drawing.

That reminds me. Incidentally, several years ago, one of the medical students rotating on the psychiatry consult service drew a picture entitled “The Practical Psychosomaticist” which contained images of stairs running in different directions similar to an Escher drawing (see the featured image). It was really just her expression of how I got around the hospital. I avoided elevators and always took the stairs.

Anyway, I’m carrying several notebooks and loose papers keep falling out. I get lost in this jumble of halls and stairways, never finding my destination.

The dream is probably just me telling myself I’m failing at something in my waking life. It’s not like I need a dream to notify me.

This is a long way of saying I have many regrets, and that I may not know exactly how many. Some of them are less important than others. Take the “I’ll never be a scientist” theme. I’m not terribly broken up about it.

After all, rodeo clowns do pretty important things.