I saw a couple of brief news alerts indicating that progress toward reclassification of marijuana from Schedule I to III could be happening as soon as today according to a Reuters report. I think that means we should pay attention to other stories and reports of cannabis use being associated with higher rates of psychosis in adolescents. That information is not new and it has been reported since at least since 2010.
The DEA is in charge of reclassification of substances.
I’ve just finished reading a couple of online articles about Chatbot use by patients who then present either to psychiatrists or psychotherapists (not that they can’t be one and the same!) and I’m a little puzzled. The title of my blog post came partly from what my wife, Sena, always says about Artificial Intelligence—which is that it needs to be dislodged.
The first article, “Clinician Competence in the Age of Chatbots,” is part of a Psychiatric Times series, “AI Chatbots: The Good, The Bad, and the Ugly.” It’s a collaboration between a psychiatrist who I admire (Dr. Allen Frances, MD) and Jill Noorily (described as someone “who lives and writes at the boundary between AI and the humanities).
I’m far from an expert on AI and I tend to be opposed to it most of the time. The article by Dr. Frances and Jill Noorily sounds almost supportive of Chatbots in psychotherapy.
The other article is entitled “Patients Bring ChatGPT to Psychiatry Visits, With Richard Miller, MD.” The tone of Dr. Miller is more along the lines of “dislodge AI” than that of the article by Dr. Frances and Noorily.
They were both published about the same time. The difference in tone between the two articles is definitely noticeable, at least to me. I’m also more like Dr. Miller than the authors of the articles in the Psychiatric Times series “AI Chatbots: The Good, The Bad, and the Ugly.”
Many of them are co-written by Dr. Allen Frances and other co-authors. The first one in the series was “Preliminary Report on Chatbot Iatrogenic Dangers,” posted on August 15, 2025 by Dr. Frances, MD and Luciana Ramos.
I quickly read through about 5 of the articles, getting a deeper sense of the conflicts I have about AI in general. The first one on iatrogenic dangers mentions the lawsuit brought by a woman whose son was the victim of a Chatbot who told him he should commit suicide—which he did.
So far, I think I have the same mindset about AI as Dr. Miller. Your thoughts?
I watched the first half of the Colts vs 49ers game last night and I thought Philip Rivers didn’t look half bad for a 44-year-old guy who’s been out of the game for five years. Did you know he has 10 kids? OK, now that I’ve got that out of my system and that would be, what—the 44th time you’ve heard that since he took the field?
So what the Colts lost? His big family was up in the stands going crazy, cheering him on.
I read an article this morning which had Steve Young saying he could make a comeback at his age—which is 64. I couldn’t believe it. The same story mentions that George Blanda played for the Oakland Raiders when he was 48 back in 1975.
It got me wondering whether I could make a comeback as a general hospital consulting psychiatrist. Could I gallop up 6-8 floors of University of Iowa Health Care? You bet your bottom dollar—I couldn’t.
It’s hard to retire. Every once in a while, I miss hiking up and down the hospital with my camp stool, deftly swinging it around and sitting with the patients and families, telling medical students and residents all kinds of lies (I mean “wise old adages and pearls of clinical wisdom”).
I get a kick out of just wondering what it would be like. I get a vision of myself with a big, golden glowing aura of greatness around my head—until I come to my senses. Hey, nobody’s going to pay me a quarter million dollars to run the consult service for the few months I’d be able to limp around the hospital, falling off my camp stool when my legs go numb or the chair breaks.
It’s not like I can just throw a football like it’s nothing after 5 years. I’d have to prove I still have enough clinical smarts to figure out how to introduce myself (Hi! I’m Philip Rivers and you need to go long!”).
The Maintenance of Certification Circus is still a thing and it’s worse. I’m not saying doctors don’t undertake the arduous task of essentially retraining to be what they once were—because that’s not good enough anymore.
Last night, the camera caught Phil more than once being just as hard on himself as he was with other members of the team who weren’t in the right spot at the right time. Most physicians are perfectionists and if you’ve been out of the game for a while and you try to squeeze back in, you could wind up mumbling to yourself, “They don’t make footballs like they used to!”
I didn’t stay up for the second half of football game. It wasn’t because of anything Philip did or didn’t do on the field.
I just can’t stay up that late nowadays.
This just in! University of Iowa Psychiatrist Dr. Susan Shen, MD, PhD, is an assistant professor of psychiatry at The University of Iowa Carver College of Medicine and, hold on to your hat, she’s the first female psychiatrist, the first from Iowa, and only the third psychiatrist overall to receive to win the Avenir Award (French for “future), a highly competitive grant!
The $2.3 million dollar grant will help fund her lab’s research into the underpinnings of substance use and psychiatric disorders. The grant is administered through the National Institute on Drug Abuse (NIDA), one of the National Institutes of Health (NIH).
Give Dr. Susan Shen a big shout-out!
I just saw a news item today that is interesting for two reasons, at least to me. It’s about people who have Cannabinoid Hyperemesis Syndrome. The physician interviewed for comments about it is Dr. Chris Buresh who used to be an emergency department physician at the University of Iowa. He’s now at the University of Washington UW Medicine and Seattle Children’s Hospital.
His comment was published in a couple of local newspapers and he pointed out that even small amounts of marijuana can make people start throwing up.
The other reason it’s interesting to me is that I gave a grand rounds on eating disorders back in 2016. I had a slide on Cannabinoid Hyperemesis Syndrome (see featured image above). There’s a reference from 2016 that probably is still useful.
Sena alerted me to an article about the 28th anniversary of when the first Men in Black movie hit the theaters in 1997. The author praises it and says it’s still pretty good.
I can’t remember the first time I saw it, but it was probably not in 1997. I was in my second year of being an assistant professor of psychiatry at the University of Iowa Hospitals & Clinics (now called University of Iowa Health Care). I was too busy to do much of anything except run around the hospital responding to requests for psychiatry consultations from medicine and surgery. I did that a long time.
I’ve been blogging since 2010. I cancelled my first blog which was called The Practical Psychosomaticist. I then restarted blogging, calling it Go Retire Psychiatrist. One blog that pays homage to my career and to the Men in Black films is “The Last White Coat I’ll Ever Wear.”
It’s part reminiscence and part comedy in the style of Men in Black dialogue and jokes. Since I retired, I have not been back to the hospital except for scheduled appointments in the eye and dentistry clinics. I don’t know if I’ve ever reconciled myself to being retired. If someone were to tell me “We have a situation and we need your help” (think Men in Black II), I would probably say something like “There is a free mental health clinic on the corner of Lilac and East Valley.”
I’ve been reading about artificial intelligence (AI) in general and its healthcare applications. I tried searching the web in general about it and got the message: “An AI Overview is not available for this search.”
I’m ambivalent about that message. There are a couple of web articles, one of which I read twice in its entirety, “Are we living in a golden age of stupidity?” The other, “AI, Health, and Health Care Today and Tomorrow: The JAMA Summit Report on Artificial Intelligence”was so long and diffuse I got impatient and tried to skip to the bottom line—but the article was a bottomless pit. The conflict-of-interest disclosures section was overwhelmingly massive. Was that part of the reason I felt like I had fallen down the rabbit hole?
I recently signed an addendum to my book contract for my consult psychiatry handbook (published in 2010, for heaven’s sake) which I hope will ultimately protect the work from AI plagiarism. I have no idea whether it can. I delayed signing it for months, probably because I didn’t want to have anything to do with AI at all. I couldn’t discuss the contract addendum with my co-editor Dr. Robert G. Robinson MD about the contract addendum because he died on December 25, 2024.
I found out today the book is old enough to find on the Internet Archive as of a couple of years ago. One notice about it says “Borrow Unavailable” and another notice says “Book available to patrons with print disabilities.”
All I know is that an “archivist” uploaded it. The introduction and first chapter “The consultation process” is available for free on line in pdf format. I didn’t know that until today either.
Way back in 2010 we didn’t use anything you could call AI when we wrote the chapters for the book. I didn’t even dictate my chapters because the only thing available to use would have been a voice dictation software called Dragon Naturally Speaking. It was notorious for transcribing my dictations for clinic notes and inserting so many errors in them that some clinicians added an addendum warning the reader that notes were transcribed using voice dictation software—implying the author was less than fully responsible for the contents. That was because the mistakes often appeared after we signed off on them as finished, which sent them to the patient’s medical record.
Sometimes I think that was the forerunner of the confabulations of modern-day AI, which are often called hallucinations.
Now AI is creating the clinic notes. It cuts down on the pajama time contributing to clinician burnout although it’s not always clear who’s ultimately responsible for quality control. Who’s in charge of regulatory oversight of AI? What are we talking about?
I watched the Svengoolie show movie, “The Baddest Seed on the Planet” yesterday on the Internet Archive because I wanted to see the Iowa Hawkeye vs UMass football game last night. Hey, the Iowa Hawkeyes and the Iowa State Cyclones both won yesterday!
Actually, I thought “The Bad Seed” was a pretty good movie, just to let the shrilling chicken out of the bag. It’s a good break from the rubber mask, stop motion animation, shlocky howlers. It does run long, a little over 2 hours and at times there’s a little too much lofty psychoanalytic dialogue. At times it seemed like a play.
It’s a 1956 Warner Bros. Pictures production. There was a Perry Mason regular on it; William Hopper played Col. Kenneth Penmark (father of Rhoda). Henry Jones played Leroy, the really creepy sociopath handyman who had a lot in common with Rhoda (played by Patty McCormack), the psychopathic 8-year-old daughter of Kenneth and Christine Penmark (played by Nancy Penmark). Eileen Heckart played the heck out of her role as the tipsy Hortense Daigle, mother of her unfortunate murdered child Claude—who is never seen.
The main underlying theme is the question of whether psychopaths are born bad or victims of bad environments.
How this gets treated in the film is fascinating. When Rhoda saws through a fawn with a dull straight razor while singing Elvis Presley’s “Don’t Be Cruel,” it really doesn’t leave much to the imagination.
Things start to go bad early when Claude wins a penmanship award instead of Rhoda who is thinking, “OK bud, over your dead body!” I’ve got to tell you; I got chills just looking at her after a while.
The handyman Leroy pegs Rhoda for a bad seed right away, mainly based on the idea that bad seeds think alike. He keeps telling her he’s got her number until he has a close encounter of the excelsior kind, and “excelsior” means ever upward only in the sense that burning wood shavings used for packing fragile items tend to be carried by the wind.
Just to gloss over the scientific psychiatric literature on psychopathy, the most recent paper I could find on the web suggests that structural and functional brain abnormalities of psychopathic persons contribute substantially to the observed behavioral patterns of callousness and poor adaptability to prosocial motivations beginning early in life and which tend to be resistant to change as one gets older. The younger the person, the more plastic the antisocial traits may be to change via behavioral modification, hopefully leading to greater empathy. (Anderson NE, Kiehl KA. Psychopathy: developmental perspectives and their implications for treatment. Restor Neurol Neurosci. 2014;32(1):103-17. doi: 10.3233/RNN-139001. PMID: 23542910; PMCID: PMC4321752.)
By far, Hortense Daigle has the most awkwardly comical role as she combines grief, inebriation and eerie suspicion of Rhoda in her own son’s death. Every time she shows up to the Penmark house, she’s roaring, dramatically staggering drunk. She helps herself to the booze in the house, even making it clear which bourbon she prefers (Never mind my grief! I said I wanted that martini in a dirty glass!).
Other than the movie being a bit too long, I thought it was very good. I could have done without the theater like credits with all the actors coming out to take a bow (or curtsy in Rhoda’s case), a slapstick bit between Christine and Rhoda, and the warning to the audience not to reveal the ending to anyone.
There’s a new podcast in town from The University of Iowa Health Care and the title is “When to Suspect Atypical Recreational Substances.”
This is a fascinating topic and the discussion ran for close to an hour, which is longer than usual because there’s a lot to say about it. The substances include a lot of chemicals that are not illegal and, in some cases, easily available in convenience stores and gas stations. In fact, the name for one of them is gas station heroin, which is tianeptine, approved in other countries as an antidepressant.
The discussion also included substantial information (or maybe better said, lack of enough information) about bath salts (usually cathinones), kratom, and something I’ve never even heard of: diamond shruumz (chocolate bars which can contain various substances not limited to psilocin). Remember that guy who chewed the face off of somebody in Miami in 2012? That was attributed to intoxication with bath salts.
This is way beyond the 1970s stuff like window pane or blotter (LSD) and pot. Many people end up in emergency rooms for evaluation of what looks like poisoning from multiple drugs. The stickler is the possibility that they got poisoned from something bought at a convenience store. Often it’s difficult to tell what the person ingested.
One of the takeaways from this podcast is that, whenever possible, try to get a history from the patient. They might just tell you what you need to know.
I’ve been looking for other ways that Iowa addresses mental illness and its impact on homelessness and other adverse outcomes since my last post on the issue.
It turns out that, despite Iowa ranking 51st out of all U.S. states for the low number of psychiatric beds according to the Treatment Advocacy Center statistics (in 2023, it had just two beds per 100,000 patients in need), a new mental health court established in in May of 2023 has made substantial progress in reducing the number of crisis contacts, psychiatric hospitalizations, and days in the hospital. Arrests, jailings, and days in jail were also reduced.
Participants in the new program include the University of Iowa Health Care, Iowa City VA Hospital, the Abbe Center, Guidelink Center, National Alliance for the Mentally Ill (NAMI), Shelter House, and several other mental health service agencies in Johnson County.
The Johnson Mental Health Court continues to operate since June of this year when the pilot program’s funding from the East Central Iowa Mental Health Region was supposed to have ended on June 30, 2025, due to the change in mental health regions. This is a program for patients under involuntary mental health commitment that avoids incarceration and placement in a state psychiatric hospital.
This civil mental health program didn’t exist until well after I retired and I hope for its continued success.
Luett, T. (2024, April 24). Civil Mental Health Court in Johnson County finds success in first year. The Daily Iowan. https://dailyiowan.com/2024/04/24/civil-mental-health-court-in-johnson-county-finds-success-in-first-year/ Accessed July 30, 2025
Mehaffey, T. (2024, April 14). News Track: ‘Challenging, rewarding’ first year of Johnson County mental health court. The Gazette – Local Iowa News, Sports, Obituaries, and Headlines – Cedar Rapids, Iowa City. https://www.thegazette.com/crime-courts/news-track-challenging-rewarding-first-year-of-johnson-county-mental-health-court/ Accessed July 30, 2025.
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