How Patient Suicide Affects Psychiatrists

Mental-health practitioners whose clients kill themselves can face stigma from their colleagues, lawsuits, and a toll on their own psyches—making them less likely to take on suicidal patients who need their help.

Unlike most other medical specialties, where deaths are routine, suicide is imagined to be preventable. Very often it is not, any more than death from most cancers can be prevented. If all suicides were caused by simple depressions curable by a pill, that would be different. However, it's not like that. Intractable, relentless emotional pain is only one of many paths to suicide.

Like most Psychiatrists, I have had a number of them in my practice. It happens if you take on difficult cases or cover ERs.  Despite all I know about suicide, it still does shake one's confidence and excites the ambulance-chasers. Most suicides, of course, never seek any help from physicians, and some who do, lie.

I recommend this game to those who are hypersensitive to rejection: By Making A Game Out Of Rejection, A Man Conquers Fear

Look, everybody must come to terms with the fact that most people will not like us, or be interested in us, or want to help us. That's part of growing up. Despite that, there are plenty of people out there who want a friend. We have to understand that others, like us, are discriminating in their own ways. When friendships and relationships do click, it sure is fun and life-enriching, isn't it?

I once helped a very shy young fellow deal with his fear by commanding him to introduce himself to a pretty girl on a daily basis - including in NYC stores (eg Bloomingdale's), gourmet food markets, and supermarkets. He complied bravely with great faith in my advice, and in a very few instances somebody liked the cut of his jib and his (apparent) confidence and phoned him. Cured by Reality Therapy! He did not become thicker-skinned, just realistic.

I am not the only one here who has been changed by Merton's The Seven Storey Mountain.

Here is  A letter to Thomas Merton

I read somewhere that Bob Dylan (a self-described "song and dance man") once tried to meet a girl in front of NYC's Metropolitan Museum by asking her "D'ya want to come in with me to look at some pretty pictures?"

Cute, and right. Better than "Come up and see my etchings." The young woman in question, if I recall the story right, said "No, thanks" to the scruffy little guy.

Like most people, I do not know what art means. It's maybe a useless word. "Craft" is a very useful word. "Creative" is a useless word unless applied to Michelangelo, Picasso, or Shakespeare, but even then I dislike the word.

From The Death of the Artist—and the Birth of the Creative Entrepreneur

I’m not sure that artist even makes sense as a term anymore, and I wouldn’t be surprised to see it giving way before the former ("creator"), with its more generic meaning and its connection to that contemporary holy word, creative. Joshua Wolf Shenk’s Powers of Two, last summer’s modish book on creativity, puts Lennon and McCartney with Jobs and Wozniak. A recent cover of this very magazine touted “Case Studies in Eureka Moments,” a list that started with Hemingway and ended with Taco Bell.

When works of art become commodities and nothing else, when every endeavor becomes “creative” and everybody “a creative,” then art sinks back to craft and artists back to artisans—a word that, in its adjectival form, at least, is newly popular again. Artisanal pickles, artisanal poems: what’s the difference, after all? So “art” itself may disappear: art as Art, that old high thing. Which—unless, like me, you think we need a vessel for our inner life—is nothing much to mourn.

I always admired Victor Frankl, but I am with Schneiderman (and David Brooks, et al) on the essential narcissistic delusion in "the search for meaning."

It has always seemed grandiose to me, but I understand that Frankl needed to find some purpose or reason to hang on, as do most people in prison camps. In the end, he produced a work which is inspiring to many.

It's easier for me, with an ordinary life, to get my mind around the search for simpler things like money, good food, romance, being useful, raising kids, living with integrity, being a good friend and spouse, and the like. When it comes to ultimate meaning, I'll go with Jesus and won't presume to invent my own. I am not smart or inspired enough to do that even if I wanted to.

From Richard Friedman,  You’re feeling down, and your doctor or therapist has confirmed it: You have depression. Now what?

Anybody with clinically-significant depression needs psychotherapy at the least.

Why elderly couples often die together: the science of broken hearts.

No matter how much you may fight and argue, you become bonded tight over years if you are even half-normal. It is a wonder, given all of our annoying flaws.

Ladies do love their orgasms and tend to value them more highly than men do. They are deeper, and last longer, than the male version.

I have known women who come to orgasm when just making out with their hubbies, and women who cannot achieve climax after an hour of rambunctious bedroom fun. Quite a few women have orgasms with exercise in the gym, on horses, or with a quick masturbation. It's a spectrum, and I do not think that it is mainly psychological. Male primates were designed to spread their alpha seed by any means possible, and they did, and still do, often selfishly without extensive attention to female satisfaction. Biologically, the female pleasure component is just gravy but it makes the fellows feel extra happy.

Women envy those hot women who can orgasm after a minute of sexual activity. Most can not. One lucky gal I spoke with told me that she orgasms the instant her husband's organ touches her labia, and goes on for six or seven more thereafter in twenty minutes. Guys love women like that but it is relatively rare. It seems to be mostly about the anatomy of the clitoris although in the first episodes of a hot new romance anything can happen.

Oxytocin is good stuff.

What do most men need and want for a good life?

An update from Dr. George Vaillant's remarkable long-term study (since 1938) of men's lives: Insights from the Longest Longitudinal Study on Men Ever Conducted:

 Character traits matter too, but even then their real importance is helping us replace a scattered narcissism with the steady maturity that leads to rewarding relationships. Perhaps it sounds cheesy, but we are ultimately here to love, and to be loved. Love leads to our ability to “put our trust in life” and the confidence to tackle our goals. Thus if we fill our lives with warm, rich relationships, all the other good stuff – career success, prestige, adventure – will be sure to follow.

Do you know what it is?  There are now Crossfit gyms all over America. It's a new arena for athletic, especially strength, competition.

It's time for 2015 travel planning if we have not done that yet (most have done so already, I suspect, but some people are last-minute "planners").

I have a new case of a fellow who has developed a travel phobia. To be accurate, he has not really developed it, it has just been exposed by his frustrated family.

Many people with fears of all sorts never have them exposed because they find ways and excuses to avoid the things that make them uncomfortable. Typical excuses: "I hate cocktail parties," "I hate going to sports stadiums," "I don't want to go to that stupid place," "It's dangerous," "I hate cities," "Airplanes suck," "It's too expensive,"  "I don't need any new friends," etc etc.

Phobias are more often identified by avoidances than by real episodes of fear or discomfort. How does one tell what is a phobic avoidance from a plain dislike? Well, a little ruthless dose of self-scrutiny can answer most of your questions about your own fears and insecurities.

Like agoraphobics, travel phobics dart from place of safety to place of safety and familiarity no matter how often over-visited, never enjoy the trip or the adventures of life, and constrict their experiences and the richness of their lives in the process. Carpe diem. Life is short and shorter with each new day and each new year.

Men are particularly reluctant to admit flaws and weaknesses.  Pride and shame prevent people from owning up to the personal weaknesses of their fears and frailties. I give blogger Ann Althouse, for example, credit for acknowledging her travel phobia (she feels that a driving trip from Madison to Austin is a daunting adventure). Properly naming one's fears, instead of making excuses, is the first step towards addressing them and conquering them.

What we term "simple phobias" are among the easiest things we shrinks have to deal with. In my experience, people with travel phobias and adventure phobias, once mastered, want to go everywhere and do everything.

How Fat, Big Boobs, and Propriety gave us The Stethoscope

In the UK, docs must now report weight-gainers to the government. 

Is that the first step towards making being fat a crime? That's a country in which it is now a crime to put your garbage in the wrong bin. That is not from a Monty Python skit.

We always figure that if you get fat and die young, you save money for the government. So why not encourage obesity? America does, by asking people to eat carbs as a diet despite sedentary lives.

Anybody can be in error once in a while. Our friend Schneiderman has seemed to miss the point here because these people are not fragile. They are venomous: Trigger Warnings and Trauma

It's all pure manipulation. There is no real neurotic hypersensitivity there. Play-acting, like drawing a foul. In today's politicized world, people use contrived pain as a tool of aggression and control, just as borderlines do.

but you will not be happy with it. Say Goodbye to the Family Doctor - Young doctors are increasingly becoming employees rather than independent practitioners.

Not only will they not know you (other than your chart data), but they will have no connection with you. We are approaching the tail end of a long era of personal and personalized medical care.

A physician can not be commoditized, but they can try. A physician is more than a technician.

It's called "horizontal gene transmission." The gene that jumped - Genes that leap from one species to another are more common than we thought.

The know-nothings out there know nothing about biology.

Reposted and revised -

It's a cliche, isn't it? (I don't know how to put accents on words on this machine.) Lonely and isolated people feel lonelier during holidays.

Let's all think about, and try to include, the lonely this year.

We are told that holidays are supposed to be times of special social fun as well as family time, whether the 4th of July, Thanksgiving (we always try to include some close friends), or Christmas season which many like to use as an excuse for throwing a party for all their 200 closest friends or just a fish supper with a handful of good pals on Christmas Eve after church (with Eggnog of course).

People obviously vary a great deal in the extent of their social connections and (cliche again) one can easily be lonely in a crowd. Many prefer to be isolated but I think there is a basic human need to be "in community," to have human connections of all sorts outside of family. We are tribal creatures. I feel sad for those who lack tribes with whom to touch base and reconnect during the holiday season. That makes it depressing indeed because it's supposed to be about fun fun fun and party party party, right?

(As an ex-drinker who used to have some degree of social insecurities, I have learned how to have a good time at parties anyway. I like to touch base with the people I enjoy, and I like to walk up to strangers and say "Hi. I'm Joy. I don't think we've met." If they don't love me, it's their loss but maybe mine too. Rejection is just part of life, and many people seem to feel that they already know enough people unless you wow them in some way.)

There are many ingredients to constructing a satisfying life, but what a satisfying life means is different for everybody. However, I believe that to be in community, or really a part of multiple communities, is a key component. Some care about it more than others, for certain. With a little luck, the construction begins with an anchor solidly lodged in immediate or extended family, and extends, in separate but often-overlapping circles, out from there depending on what one does or decides to build.

And I do mean "build." Like career, community is never handed to you on a silver platter. I like to connect with interesting, intelligent, positive, and amusing people with interesting and adventurous lives. Who doesn't? On Saturday night, I met a gent, a retired banker, who covered the erection of the Berlin Wall for the New York Times when he was 21 years old. He had taken his grandkids to the Checkpoint Charlie museum in Berlin this summer. I want to include him, and his wife, in one of my circles.

More below -