Go Retire Psychiatrist

House Hunting Disorder

House Hunting Disorder might be my suggestion to add to the Diagnostic and Statistical Manual (DSM) of Mental Disorders, whenever the American Psychiatric Association gets around to updating.

Shopping is not one of my favorite things to do. Shopping for houses (especially a retirement home) is something I would suggest running away from if you have any choice—which you won’t, trust me. We’re not yet ready for the Vintage Cooperative, a condo-like setting for seniors. I’m almost ready to settle for an apartment.

I’m remembering our first “apartment” when we moved to Hawkeye Drive in Iowa City over 30 years ago. It was University of Iowa housing and my wife wept openly when she saw it. The moving van sat in the office parking lot for at least a couple of hours while the truth sunk in. The only other choice was Hawkeye Court, but that was not the one to which we were sentenced—I mean, which we, like a lot of other students, signed up for, sight unseen, when we moved here so I could start medical school. They were painted cinder block buildings described as resembling “minimum security prisons,” and had been around since the 1960s. They were all torn down to make way for new student housing around 5 or 6 years ago.

We were on the 3^rd floor so we had to lug our furniture up to the top. I had problems with my knees then, which, miraculously, I don’t have now that I’m decades older. Over time, the place developed a constant buzzing noise from a vibration which I think began in the shared 1^st floor laundry room where all the poltergeists lived. It drove me nuts—from which I obviously never fully recovered. I couldn’t convince the maintenance man that the noise even existed. He looked at me sort of wide-eyed and edged away from me as I placed his hand on the sofa to demonstrate how you could actually feel the vibration all over the apartment.

The neighborhood was a little scary occasionally. On one Halloween night, we got a visit from some very tall kids who were not wearing costumes, smelled of beer, and held out what looked like giant lawn and leaf bags. They said “Trick or Treat” in pretty deep voices for children. I probably shouldn’t have asked, “Aren’t you a little old for this?” as I dropped a few candies into the bags, which I could have stepped into and been completely concealed. When I closed the door, we could hear the candies shatter against it.

The next apartment we rented had a small blister in the ceiling which grew quickly over a day or so into a beach ball-sized bulge. It happened over a weekend and the manager claimed he couldn’t get anybody to fix it until Monday. We spent some tense moments just watching and waiting for the bleb to explode all over the living room.

OK, so maybe apartments are out. We’ve lived in a several houses here since then, which are really markers for my career in medicine as well as domiciles. Things have changed in the real estate market. Homeowners Associations (HOAs) are just one of the changes.

HOAs are something I would rather avoid but may not be able to escape. I could weep openly about them, but it won’t help. The explanation for them, which comes from developers most of the time, is that the Post Office doesn’t want to deliver mail to each and every house nowadays. This has led to the proliferation of mailbox clusters, which have to be maintained at HOA expense. Sometimes it amounts to scooping snow off the concrete pad on which the mailbox cluster sits.

HOA fees are a nuisance. They can run from a few dollars to a few hundred dollars a year, which I admit is better than association fees for condos, which can run into the thousands. What the fees cover is sometimes difficult to discern. A lot of developers and builders nowadays erect subdivisions in locations which I suspect would have been avoided in decades past. Some of these areas tend to be called “wetlands,” which are ponds surrounded by tall grasses and which foster the evolution of various life forms that sometimes crawl up on land to feed on small mammals.

You can sometimes escape the HOA madness by buying older homes in what are called “established neighborhoods” where the residents raise chickens, hunt for mastodons, and park RVs in their driveways that are bigger than their houses. There are unwritten rules which include but are not limited to animal sacrifice. But at least they don’t have covenants that require you to have an 8-foot-tall lamp post which must remain on 24/7; a stamped and gaily-painted driveway (multi-cultural themes only), stone columns quarried in Portugal, and a bat-infested entry and those bats better be neutered or spayed, vegan, rabies-free, defanged and declawed, and be multi-lingual.

HOAs require at least 4 officers (President, Treasurer, Secretary, Executioner), elected as soon as the last nail goes into the last house on the last empty lot in the subdivision. The President should carry personal liability insurance against the possibility the neighbors will file a lawsuit about the conservation areas being infested with non-native vegetation, such as lichen or cobwebs.

HOAs can’t protect you against builders, which are another hazard which you can’t avoid unless you are capable of building your own house, which you are not because, as you well know, there are only two kinds of people in the world—builders and victims of builders. You know who you are.

Speaking of building, what’s up with mud rooms being placed in the layout not where they make the most sense, which is immediately in from the garage door entry, but in what I think is called the Jack and Jill arrangement? This puts the mud room next to the laundry room next to the walk-in master closet which is off the master bathroom, which leads from the master bedroom, all in a straight line and all separated by the mandatory pocket doors which must be filthy and get stuck halfway out according to the building codes. Needless to say, the mud room need not be in close proximity to the garage entry and is often close enough to the front door that you have to track mud from there to the mud room—or across the front room to the kitchen, which makes about as much sense. The obvious conclusion here is that Jack and Jill were sadistic fiends called up using the Ouija board. At least that’s who the builders will tell you to blame.

I could go on but I’ve got other stuff to do today, like shop for houses. I know it’s a sickness and I should get some help—but there’s no treatment.

Over the Double Rainbow

We saw a double rainbow while out for a walk during a gentle rain. I know they’re not rare, they form because light bounces off raindrops, and all that. I’m not after the science angle here. I’m just hoping this was a sign of good luck to come. I’m pretty sure I’ve probably seen a double rainbow before. I just can’t remember when. And I doubt it was as striking as this beauty was.

These days I’m wondering what’s over the rainbow or the double rainbow. Going for a walk the other day helped me put things in perspective—at least for a while.

Out for a walk in the fall

My life is slower when I’m not on service in my role as a general hospital psychiatric consultant. And I’ll be fully retired in June. I just came off service earlier this week, when I was going at my usual fireman’s pace. Things seem to move so much faster nowadays.

I’m on service at 50% time now. That feels a lot different than the previous two years, when I was at 65% time. When I’m on, I’m going at a dead run. When I’m off, I just mosey along. It’s a little jarring to go from 0 to 90 and back again every so often—even though it’s less and less often.

I don’t mind telling you, I get a little bored sometimes. It helps to do something different every once in a while. I hadn’t made a pizza from scratch in over a year and a half. I guess it’s not completely from scratch. I’m still better at just sticking a frozen one in the oven.

Make that pizza!

A Beer Called Ruthie

Ruthie is a good name for a beer. It’s a craft brew made by Exile Brewing Company in Des Moines, Iowa. It was named the official craft beer of the Iowa State Fair this year.

There’s a cute picture of Ruthie on the bottle pouring beer into a couple of glasses balanced on her bosom. Where else?

It turns out that Ruthie Bisignano was the owner of Ruthie’s Lounge in Des Moines, open from 1950-1970. She was nationally famous for this kind of serving style. She was married sixteen times to nine men, by her account, according to a Des Moines Register clipping from 1988. This was the year my wife, Sena, and I moved from Des Moines to Iowa City in a U-Haul truck so I could start medical school.

Exile was established in 2012 and they serve community healthy living awareness as well as beer and food. For example, they started the Ruthie Breast Cancer Campaign in 2018 and for every case of pink-labelled Ruthie beer sold, a dollar was donated to Susan G. Komen Greater Iowa. They have a well-balanced attitude toward health and life—sort of like the well-balanced way Ruthie served beer.

We noticed that one of the menu items was something called Mexican Rarebit. It reminded me of a Gomer Pyle episode back in the 1960s. If you’re not a baby boomer, you might not know anything about this old TV comedy involving the stormy relationship between a naïve Marine private and his grumpy drill sergeant, Vince Carter. It ran for 5 seasons and, while it was one of the few programs my mother liked, Sena hated it mainly because of Gomer’s over-done North Carolina hick accent.

Anyway, one of the episodes was “Gomer the Welsh Rarebit Fiend.” In it, whenever Gomer or Carter ate what Gomer always sounded like he called “Welsh Rabbit,” they would sleepwalk and switch personalities. An article on the web about the episode showed many snapshots from it, one of them including a sign on which was printed “Psychiatric Unit.”

Of course, that piqued my interest since I’m a retiring psychiatrist. I didn’t remember that part of the episode. I searched the web and discovered that Welsh Rabbit was the original name of the dish, which is a simple dish of mainly melted cheddar cheese on toast. I admit I don’t understand the etymology of the name. Somebody either couldn’t catch rabbit or pronounce it.

However, it’s been associated with causing vivid nightmares, especially if you eat too much of it late at night. Maybe it’s the mustard.

In fact, there was an early 20^th century comic strip called “Dreams of a Rarebit Fiend” by Winsor McKay. It was about spectacular dreams caused by eating Welsh Rarebit. The dreams often portrayed Freudian themes including phobias. Some speculated they might have inspired iconic movie creatures like King Kong.

Anyway, Exile’s Mexican Rarebit sandwich involves ground chuck in a spicy queso, bacon, and corn salsa. I wonder if the recipe calls for beer, which might be another way to enjoy the Ruthie. The web site doesn’t warn the diner to avoid eating it just before bedtime.

You can find a lot of different recipes for Welsh Rarebit, limited only by the cook’s imagination.

Sena just returned from the store and among the items was cheddar cheese and pumpernickel bread.

I made what we’ll call Ruthie Rarebit today—with a heck of a lot of coaching from Sena. The recipe was pretty traditional:

A stick of butter, about a tablespoon of flour; aged cheddar cheese, about one and a half cups, enough for both of us; a small carton of whipping cream; about a teaspoon of dry mustard, half of a 12 ounce bottle of Ruthie Gold Lager (could as well have used the whole thing); salt and pepper, a little paprika and cayenne pepper.

Toast a couple of big slices of bread (we used pumpernickel) with a little olive oil in a pan. Melt a stick of butter in a saucepan, add about a tablespoon of flour, a bottle of beer or ale, whipping cream, add the cheddar cheese, and keep stirring. Pour it over the toast and add whatever else you want on top.

No Welsh Rarebit recipe calls for rabbit—that I’m aware of, anyhow. I’m not expecting any nightmares tonight. In fact, I think it might be as helpful for sleep as melatonin.

See how it’s done!

Let Happiness Leak

This is just a post to offset the grumpy one from a couple of days ago. Sena and I took a walk on the Clear Creek Trail and she broke me up with her shenanigans.

Along the way, we found a painted rock in a tree which had the word “corridor rocks” printed on it.

It looked like something you could google—which I did. It’s a cute story titled “The Corridor Rocks! —Brightening Days One Stone at a Time” by Sara C. Painting rocks, hiding them and giving people like us a fun time discovering them. Sara says it was a way to stop and smell the roses.

It’s one way to remember how happiness works. It leaks…sort of. We put the rock back where we found it. The only clue we’ll give you is that it’s somewhere out there on the Clear Creek Trail. Have fun!

Signs to Guide Me

It’s been a long while since my last post. I’ve been busy looking for signs to help guide me in adjusting to this retirement gig. It’s a tough skill set to learn.

I saw this bug on our house the other day. It turned out to be a Praying Mantis. Don’t quibble about the precious difference between mantids and mantises—I don’t have the patience for that. Anyway, this one didn’t have the typical pose, with the long forelegs cocked into a prayerful posture. It looked more like it was just trying to find its way—kind of like how I feel.

I read a little bit on the web about the Praying Mantis. One culture says seeing one is good luck and another says it’s bad. I read just enough to hope there is no such thing as reincarnation. I hope never to come back as a male Praying Mantis, if you get what I mean. Look it up.

What I really would appreciate is somebody telling me about what would be the best way to adjust to retirement. Many days go by when I struggle to shake the notion that I was never really any good at anything other than being a doctor.

I need a sign. I need many signs, as a matter of fact. Just to clear my head, I went for a long walk out on the Clear Creek Trail. I noticed quite a few signs out there. Most of them seemed to have some special significance. That’s just because I’m preoccupied with getting used to being retired.

There were signs of September on the trail. Specific signs telling you to do something or not do something else. And there were signs that you generally see every September that tell you autumn is on the way.

It reminded me of that song, “Try to Remember,” which has always struck me as lugubrious.

I just need a sign and I don’t care if the Praying Mantis points it out or not.

Ten Month Countdown to Retirement

Starting this month, I’ve got a 10-month countdown to retirement. I was reminded of that when I got a brochure in the mail for the University of Wisconsin 7^th Annual Update and Advances in Psychiatry. It’s scheduled for October 11-12, 2019 at the Monona Terrace, which is the usual location.

I’ve received these announcements in the mail every year for longer than 7 years. I’ve never had the time to make it to a single of these meetings. I’ve always been on duty. I’m not sure why they are advertising them as though they started only 7 years ago.

I can remember getting an announcement in 2009 in which the title of the update was Nontrivial Neuropsychiatric Nourishment from Noble Notable Nabobs. How’s that for a sense of humor? There were several like that prior to 2009 but I never kept the brochures. I haven’t seen any brochures like that for the last seven years.

I don’t know who came up with the humorous titles. I wonder if it was Dr. Jefferson. I noticed this year’s brochure had an In-Memoriam notice about James W. “Jeff” Jefferson, MD, who has been a luminary of psychiatry for decades. He was also a major presenter at these psychiatry advances meetings. He was active in psychiatry for over 50 years.

And me? I’m retiring after a much shorter career, by comparison. I’ve been running all over the hospital as a Consult-Liaison Psychiatrist during the busiest time in academic medical centers everywhere–July and the early part of August when senior medical students become full-fledged resident physicians. Newly-minted doctors tend to request many psychiatric consultations. On average I’m putting close to 4 miles and 30-odd floors on my step counter (with C-L psychiatrists, maybe it’s not the years but the miles that count—literally). I’ve not taken vacation during the past 2 years of my current phased retirement contract—and don’t plan one for this final year.

That reminds me of time in 2012 when my wife, Sena, and I went to Madison, Wisconsin on a vacation, the first in a long time. The residents were wondering when I was going to get away. Madison is a great place to visit and we lived there briefly when I took a stab at private practice.

We stayed at the Monona Terrace, which gives a great view of Lake Monona. We loved Olbrich Botanical Gardens. We rented a couple of bikes at Machinery Row Bicycles and rode all the way to Olbrich. The rental bikes were a far sight more affordable than a lot of the ones you could buy. Many were priced at several thousand dollars.

And I found an old copy of Robbins Pathologic Basis of Disease at Browzers Bookshop on State Street. I used that book as a medical student. My class used the nearly 7 pound red 3rd edition containing 1,467 pages. This book is hailed as an outstanding foundational text, which it is. Dr Stanley Robbins has been eulogized as an exacting editor who championed writing of the type espoused by Will Strunk in The Elements of Style.

Not to be picky, but the book contained the phrase “not excessively rare” in reference to some process or disease which I can’t recall. I do recall that a majority of our class howled about this verbiage, which seemed the antithesis of what Strunk tried to teach.

You could see a lot of interesting sights on State Street. During a previous visit, we saw a guy walking down the middle of the street with a rattlesnake coiled on his head, wore it like a hat.

We had a lot of fun in Madison. It’s that kind of relaxed, good time that I want to retire to. Ten months to go.

Moaning and Groaning About Deck Maintenance

We’re pretty dedicated to maintaining everything about our property, including deck maintenance. Check that; actually, my wife is dedicated. I’m usually hard to find when it comes to chores like that. When it’s time for deck cleaning and sealing, there is always some emergency I need to address on the other side of town or I’ve been temporarily abducted by aliens.

Sena is usually not one for moaning and groaning about these jobs, but painting the deck rail spindles is an exception—each and every spindle, separately and painstakingly swabbed with a brush so that every tiny spot is covered with sealant.

The right kind of sealant is critical. She usually likes water-based sealant, but the local hardware store salesman managed to sell her an oil-based product that was on sale. There’s debate about the relative merits of water-based vs oil-based sealants.

In general, the water-based products are a lot easier to work with and provide excellent deck protection. Oil-based sealants have been around a lot longer, penetrate better, and naturally repel water. Most of them nowadays have a low risk rating as volatile organic compounds (VOC), meaning they are environmentally safe. On the other hand, Sena is finding it takes more than one coat of the oil-based product to get adequate coverage, and she has to use a brush instead of a pump pressure sprayer. It takes longer to finish the job—which elicits more moaning and groaning.

We’re not 100% sold on the assurance by experts that either one puts down a finish that will last for several years. We live in Iowa and shovel the deck several times a season, so moaning and groaning about this could happen pretty much every two or three years.

Just for the sake of full transparency about my role in this job—I was banned last year for reasons which would normally remain opaque but who cares?

That cleaning and sealing chore last year was a major challenge. I somehow had to figure out how to reach the yard side of the spindles to cover them with sealant. The trouble was that I was not tall enough to reach them. I think it is to my credit and possibly my eternal fame that I immediately came up with an ingenious solution—a boom lift truck. I have some simple instructions to pass on to those who learn certain skills quickly and don’t mind spending a little time in a state penitentiary.

Now, we didn’t own one but it just so happened that across the street there was a lot of construction going on in a new subdivision development. The average boom lift truck with a cage or bucket would have made a pretty big dent in our bank account.

You should pick a weekend day to successfully pull this off—I mean execute this procedure. Usually the construction crews are short-handed and they’re too busy smoking cigarettes to pay much attention to what’s going on around them.

Pick a two-story house under construction, which is more likely to need a boom lift truck for applying various exterior features like windows, cedar shakes, shingles and escape hatches. It’s likely to be left running with the key in the ignition. There might be a couple of construction guys hanging around, which you can get rid of by shouting “Hey look, there goes Elvis!”

This always works—pretty much. While they raced off, fumbling with particle board scraps which they could possibly get an autograph scribbled on using lumber crayon, I climbed into the nearest boom lift truck.

There’s usually a button to start it. The one I found was already running. Reverse gear was difficult to find; it was just as easy to hit the gas and dislodge the portico cover on the way back to the street. By this time, a couple of construction workers and a rottweiler had spotted me and were racing back across the lot, yelling and barking.

This was not a problem. I managed to get the rig up on two wheels and whipped around. I contributed to their cardio workout as they sprinted back the way they came. I finally caught all of the pursuers including the dog in the basket. It didn’t take me long to figure out where to dump them. There were plenty of basement holes dug. They were making quite a bit of progress in that subdivision!

I made it back home in time for lunch. I had to eat fast because I could hear sirens up the street. I could get only a few rail spindles covered before I discovered that I might have to quick like find a hideout—I mean alternative living quarters.

Anyway, you’ll have to do some calculations to figure out how much progress you can make with this method. I’ve refined it in several ways and I plan to post an update on these instruction when I’m out on parole—I mean back from vacation.

In any case, I think Sena is doing a great job. She’s been a tireless gardener, hospital volunteer, and the best wife a guy could ask for.

Suicide Risk Assessment Update 2019

I updated my suicide risk assessment presentation today in light of new data on suicide risk assessment stratification. It turns out that using such tools might not be supported by the research evidence. That’s not going to stop the use of such tools, which include the Columbia–Suicide Severity Rating Scale, which is in wide use.

I found criticism of these scales in a recently published article in Clinical Psychiatry News, published June 21, 2019, “Why we need another article on suicide contracts,” by Nicholas Badre, MD and Sanjay S. Rao, MD.

For many years now, psychiatrists and other health care professionals have learned that trying to use no-suicide or no-self harm contracts are controversial and don’t prevent suicide. Badre and Rao sound like they’re easing away from that contention although they still say that a thorough clinical suicide risk assessment ought to be done.

Until I saw this article, I was not aware of a recent review of 70 studies showed that: “no individual predictive instrument or pooled subgroups of instruments were able to classify patients as being at high risk of suicidal behavior with a level of accuracy suitable to be used to allocate treatment.”

Carter, G., et al. (2017). “Predicting suicidal behaviours using clinical instruments: systematic review and meta-analysis of positive predictive values for risk scales.” Br J Psychiatry 210(6): 387-395.

This was even more interesting because we recently changed our practice regarding suicide risk assessments on the psychiatry consultation service based on relatively new recommendations from the Joint Commission on Accreditation of Hospital Organizations (JCAHO). The Joint Commission favors the risk assessment tools.

Of course I’m not going to second-guess the Joint Commission but after 27 years (counting residency) of struggling to assess suicide risk, I’ve learned that it can hardly be reduced to any single rating instrument.

I have often said to patients that I don’t use no-suicide contracts because they’re too much like promises—and promises are broken every day. That segues into what I prefer which is to work with the patients on developing a safety plan, which I compare to no-suicide contracts by saying “a plan is better than a promise any time.”

Working on the safety plan with patients gives me another way of assessing the strength of my alliance with them and a way to improve it as well as a method for evaluating their ability to formulate a workable way to stay safe that emphasizes their individuality.

On the other hand, the safety plan is no guarantee of safety, any more than the no-suicide contract.

But often enough I’ve gotten the sense that some patients and I have even had a little fun working on suicide safety plans—ironic as that sounds. I find how important pets are, hear little anecdotes about a favorite hobby or goal, aspirations, hopes, and memories of better times when they coped really well.

Listening for understanding to someone who is contemplating suicide or who has attempted suicide is never easy. It’s the hardest thing I do. I can’t say that I’ll miss it when I retire. I have great faith in the next generation of doctors.

New suicide risk assessment presentation

If You Can’t Stand the Heat…

We saw this rabbit in our front yard today, stretched out on the grass under our crabapple tree. It’s 117 degrees this afternoon with the heat index and we won’t get out from under the Excessive Heat Warning until later this evening. Thank goodness for air conditioning. Rabbits don’t have air conditioning and can’t escape the heat.

Sena stands the heat better than I do; she waters the lawn and garden, keeping it beautiful. On the other hand, I felt body-slammed just walking out to get the mail.

The old saying goes, “If you can’t stand the heat, get out of the kitchen.” It means you if you can’t take the pressure of a situation, then you should move and let somebody else take over. It was popularized by President Harry S. Truman, who said the originator of the proverb was Judge Buck Purcell of the Jackson County, Missouri Court—whoever he was.

Anyway, I’m on call this weekend and got to talking with a colleague who is thinking about retirement. We go back a long way in our education and careers. He asked me about what phased retirement is like. I told him I thought if I’d tried to retire outright, I probably would have just come back to work.

That’s a twist on standing the heat. As a psychiatric consultant, I’m like a fireman (get it?) in the general hospital, putting out fires, so to speak, all over the hospital. Most often the problem still tends to be delirium, an acute change in mental status that should be considered a medical emergency rather than a psychiatric problem per se. It’s just one of many crises that I encounter every day. Over 23 years (not counting residency), I learned how to stand the heat in that kitchen. When I retire, somebody else will have to get in there and cook. Speaking of cooking—I still can’t.

I guess I’m mixing my metaphors (fireman and kitchens, etc.). So what? I’m a retiring geezer and I guess I’ve earned the right to mix my metaphors as much as I want.

But in my first year of the 3-year phased retirement contract, I felt a different kind of heat–the heat of trying to find something to do with my unstructured time. It was a struggle for a guy who’s accustomed to being in almost constant motion, climbing up and down 20-30 floors (I hate waiting for elevators) and covering 2-3 miles a day.

The only trouble is—I can’t get out of the kitchen of retirement. I’m getting up there in age and even though most of the time, I seem to leave some of the trainees huffing and puffing getting up the stairs, I know they’ll replace me someday. But I can’t find a replacement to do my retirement time for me.

I have 11 months to go before I retire. I can feel the heat.

Whatever Happened to the Janus Head Logo for ACLP?

I got an email from Don R. Lipsitt, MD yesterday which reminded me of the Janus Head logo for the Academy of Consultation-Liaison Psychiatry (ACLP). It was changed to another sort of nondescript logo several years ago for reasons I didn’t understand.

Dr. Lipsitt is a luminary in C-L Psychiatry and recently published a definitive history of the field, Foundations of C-L Psychiatry: The Bumpy Road to Specialization (2016).

I posted a blog or two about Don and his book in a previous blog, The Practical C-L Psychiatrist. We’ve never formally met. A few years ago, he noticed that I had written about him and his book. I had sent him an email message about it at around the same time the APM was considering the name change for the organization, telling him that I had plugged his book and asking him what he thought of the name change. Incidentally, he thought both of our books made a great package, so I guess I’m allowed to plug mine, strangely titled Psychosomatic Medicine: An Introduction to C-L Psychiatry, editors James Amos and Robert Robinson (2010).

Don expressed his opinion about the name change:

“I feel I have dealt with that at some length in my book. I still feel C-L is most fitting and that the Board made a big mistake naming it PM. Who were they? Any C-L psychiatrists among them? Any Psychosomaticists? Why are not the “complex medically ill” a special population? And why is APA now offering courses on “integrated” care (which is what C-L psychiatry has always been about? The notion that C-L was not declared a specialty because it was considered a skill of ALL psychiatrists (with minimal training), then how do geriatric or child psychiatry become specialties (that all psychiatrists also have training in)? Don’t get me started.”

He considered his book, in large part, a “polemic” against the name “Psychosomatic Medicine.”

Anyway, the ACLP was formerly the Academy of Psychosomatic Medicine (APM) until a couple of years ago when the organization responded robustly to the membership (of which I was one at the time) to abandon the term “Psychosomatic Medicine” and adopt what rank and file practitioners preferred—Consultation-Liaison Psychiatry.

It was a kind of rebranding and it was not the first time the academy had considered a name change. I and a lot of other C-L Psychiatrists cringed at the term “psychosomatic,” not so much because of the word itself in terms of its true denotation, but because of the unfortunate negative connotations it had acquired.

Another luminary of C-L Psychiatry, Dr. Thomas Hackett, MD, wrote about the term “psychosomatic” in the Massachusetts General Hospital: Handbook of general hospital psychiatry: edited by Hackett and Ned Cassem (1978):

“The term ‘psychosomatic service’ has had a variable history. The term generally leaves a bad taste in the mouths of physicians. It reminds them of the 1930s, 1940s, and 1950s, when various psychosomatic schools espoused doctrines linking specific psychological conflicts or unique personality profiles with diseases designated as psychosomatic. Compounding this misunderstanding has been the term’s abuse by the general public, who regard anything psychosomatic as either imaginary or nervous in origin. As a consequence, most people believe that a psychosomatic disease is not to be taken seriously.”

Well, anyway, because of my anecdotage, I’ve strayed a little from my original story about the Janus head logo.

I already mentioned that the logo was abandoned in favor of something that looks like waves and could lead to seasickness. I inquired about the history of the use of the Janus head logo.

In addition to my curiosity about why the logo was changed, I also wondered why it was chosen in the first place and when. According to Don, it was part of the organization’s journal, Psychosomatics, in the late ‘60s and ‘70s. What was interesting is that it was already in use by the Journal of Geriatric Psychiatry when the Psychosomatics editors started using it. However, a conflicting view was that it was not introduced to the cover until 2010. Hmmmm.

I saw the 2012 issue of the APM Newsletter had a pretty funny picture of Drs. Shuster and Rosenstein posing as Janus and the statement “Thank you, Janus. You served us well for over 50 years.” That might put the origin of the logo, at least, around 1962 although my understanding is that APM was started in 1953 (TN Wise, A Tale of Two Societies, Psychosomatics 1995).

Time to say “Hello, again, Janus?”

It’s just my opinion, but because Janus is the ancient god of beginnings and transitions, gates, doorways, endings and time, and typically depicted as two-faced because he looks to the future and the past, I think the symbol is a better image for what C-L Psychiatry has been through over the years.

Anyone for re-rebranding and go retro back to the Janus head logo?