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Warrior-Queen is accompanying Harper and I on our walks. While we stroll she tells me about a local variety of unicorn indigenous to the desert. Who knew? She conveys having done a lot of careful research on this subject. Her fondness for unicorns extends to her clothing and her reading material which are all about unicorns.  Friday last we had a birthday party for one of her stuffed animals (a fox); the cake and cookies were unicorn-themed as shown above.

I find this fascinating. She is so serious on the subject. In general she’s rather reserved [1] but on the topic of unicorns she speaks with the enthusiasm of professor with great expertise. As I ask questions I hold back on the main one I want to ask: whether or not she believes any of this. Her sincerity and seriousness seem genuine. Discreetly I’ve asked questions not to challenge but to expand on my ignorance on the topic. She’s been consistent in her beliefs making sure I don’t mix up ‘facts’ which unicorn is which and what each does. 

I forget when children cease seeing their stuffed animals and toys as real. I suspect exposure to things via the internet speeds up the end of childhood innocence. The sad realization Santa and his sorts ‘aren’t real’ must come earlier in life than when I was a boy. [2] I wonder if her friends ‘believe as well’ or do they tell her unicorns aren’t real. If the latter, does she utilize cognitive bias to dismiss arguments contrary to her beliefs as false news and facts to go on believing what she wants to believe? [3]

Her father Brother #4 is very much into Dungeons and Dragons which at some level he knows is all make-believe. All the same he is “into it” as he is into his fantasy football; both seem ‘quite real’ in a way for him.  Perhaps WQ is no different.

I think it’s sweet she believes in a fantasy world full of unicorns of various types and colours and abilities. Using ones imagination and is useful in the development good thinking and problem solving . This makes us better persons. 

In time as she grows she will give up on unicorns and perhaps be slightly embarrassed by once upon a time belief in them, dismissing it as ‘childish’. I hope the consequence of her careful research on the topic may someday apply to scientific research or creative writing.  

Thems who travel to Fantastica come back better for having gone.

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[1] WQ is nine years old.  Last time she was here I think she was six. She was quite bubbly then and with major mood swings ranging from delightful squeals to lamentations of the worst sort. If she had been a patient I would have recommended a mood-stabilizer like lithium. I was assured she was merely being a normal six-year-old girl. Oh the pain. 

[2] I did not learn about ‘where babies come from’ until way late in grade school when a snarky boy told me at recess what had to be done. I was shocked. It sounded not at all fun and certainly nothing I wanted to do. Who says being gay ain’t inherent? 

[3] You will be shocked shocked shocked to learn this still happens even in grown ups. 

I have canceled my usual Friday night happy hour with chums to go directly home after work to attend a sort of birthday party. My niece A.K.A. Warrior Queen has arranged a soirée for her stuffed animal. She got it here last time she visited Arizona. I forget what sort of animal it is or its age. We are to have a cake and there may be prizes.  Her father, Brother #4, will be grilling something for the supper.

I am not good at grilling. Were I was better at it! This may be from lack of practice although I don’t remember being too good at it even when I tried. Once upon a time when the outside gas grill was functioning we did a lot of grilling. I was just getting the hang of it when the grill went kaput. That was years ago. We have two Webbers, a tall and a small, standing next to the defunct gas grill. Neither of the black beasts have been used in ages. Setting up the coals and waiting for them to glow and running in and out of the house with platters of food (in the ardent heat of summer) is rather time consuming.

I have a bit of guilt whenever I am grilling. As a cooking technique grilling isn’t very PC what with its consumption of coal and lighter fluid generating nasty fumes into Phoenix’ already quite polluted air. Then there is the high fat-high cholesterol meats with their charred bits full of carcinogens and nitrates (not good for health and heart). Nevertheless the cooking method is still part of a man’s measure, like changing a tire. A real man knows how to grill.

I confess grilled food is my guilty pleasure. These days I don’t each much meat and less beef but Oh! The joy of on-the-grill cheeseburger or baby-back ribs! There is nothing quite like BBQ!

I am much looking forward to tonight’s dinner. Perhaps Brother #4 can teach me some tips and I got dips on all the ribs.

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NOTE: this one was written without too much careful thought or editing. It is more catharsis than careful prose. I thought to store it away until I could carefully comb it for errors and such. I decided to post it as it is.   

When I was a newbie shrink I was filled with enthusiasm and psychoanalytical theories; I was ready to shrink heads and assist others in their exploration towards awareness and better being.  Thirty years later I am not so excited in that way. I now know many (most?) people don’t want to ‘get better’ or they lack the courage and/or resources to do so even when they want to.  A lot of my nowadays work it trying to do what I can; I try to alleviate some pain and keep major bouts from blossoming.  The vast majority of my patients aren’t looking for self-achievement; they are looking for a means to keep their symptoms from dominating their lives so they can function. Medications often work better than insight-oriented analysis when it comes to helping agoraphobia or manic reckless behavior.  For folks with intrusive ruminating thoughts it’s better to give them Prozac than to explore their alleged unconscious violent ideation towards others, which was the standard approach in psychoanalysis for the treatment of OCD.  What I professionally do, and the tools and paradigms I use have little resemblance to what I had in the early 90s. It’s like looking back in your photos to how your dressed in the 70s. Oh the embarrassment.

Sometimes I think this is a bad thing viz. being mostly someone who writes prescriptions to treat a conglomerate of symptoms. I no longer deal with patients more personal problems. It feels a bit soulless. After all Psyche is the Greek word for soul. I hear tell psychiatry residencies no longer teach psychotherapy other than the basics of how cognitive behavioral therapy works (the one therapy with data to back up its efficacy).  Having psychiatrists learn psychoanalysis has been compared to astronomy students being obliged to learn astrology.

One the positive what I do is more and more ‘evidence-based’ and not based on theories without good data to back it up.  I feel more like a proper physician. Funny how my field was once criticized for being mumbo-jumbo and now it is accused of pushing pills.

All the same it is a field constantly growing as we learn more about the puzzle that is the human brain. It’s exciting to be continually learning   albeit a bit discombobulating to have all my beliefs redone every decade or so.

It’s late and I am tired. I’ve been dealing with patients and their matters all day and into the night. It’s been a rather tough week with each day ending with a sense I don’t think I can or want to keep going.   Perhaps I will feel better about it all tomorrow after a rest. It will be another full day as I try to juggle objective scientific data with human empathy and compassion.  May my efforts do someone some good.

 

Ever since The Board of Directors Here at Spo-Reflections burned down the board room I’ve had no place to write. I start entries at various home and work computers, but these prodromal compositions get left behind like the half-consumed cups at home. I think this is my fifth attempt at writing something anything; I am darned determined to publish this one. 

After my ‘scope on Monday I’m still not feeling myself. If I were a Crayola crayon I would be in need of sharpening; if I were a podcast episode I’d be running at 1/2 to 3/4 speed.  Mercifully I can still remember my zip code and my way home from work. Someone says I am ‘somaticizing’ which smacks of temerity as I am the shrink at Casa de Spo not he. 

Speaking of Someone he did a fine job getting the house ready for Brother #4 and family (who arrive soon). He washed all the windows and he cleaned up behind things that haven’t seen daylight in ages. It all looks clean and tidy. I am glad to have my evening/weekends freed up again. 

Between work and housekeeping there’s been precious little time for anything else, including reading blogs. I feel bad when I am not regularly reading my favorites. After all if people are going to read mine I should keep up reading theirs.  I don’t recall any blogger buddy has ever objurgated me for ‘lack of attendance’ but there it is.  While my Michigan relations are in the pool this weekend I can sit on the back porch and get caught up.  It’s an ill wind that blows nobody good; my lack of time precludes me from Facebook and Twitter etc. so I feel quite relaxed not knowing what That Dangerous Clown is up to these days.* 

So that’s the quick all the news that’s fit to print and otherwise. The niece A.K.A. Warrior Queen will be sleeping in The Blue Room, where Henrik the Ghost usually hangs out when he is in town. I hope she doesn’t upset him too much. I better sign off and make one final round about the place for any missed dust bunnies or half consumed cups. I turn my back only for a moment and the Cup Fairies hit quick.

goblin

 

*No good that’s certain. 

Pensive

Once in a while all I want to do is close the door and withdraw from the world. Today is one of those days. I wish I had something important or amusing to write but I do not. I had a few ‘back up’ posts but I discovered in my rounds today many of my blogger buddies had ‘written it first’ so to publish my own would look like copy-catting. I am vain that way. 

Earlier today I wrote a piece about my colonoscopy this morning. Then I rewrote it only to erase it entirely. * I’ve felt slow and dimwitted all day, the result of having had no sleep and anesthesia. I am also feeling melancholic for a handful of reasons: I’ve learned of a trouble at work; the politics of the land are appalling; I missed a friend’s birthday. The list is longer than this but you get the gist. 

There is some loneliness happening as well. There are a handful of folks I would love to reach out to me but they are away busy I guess.  My telepathic powers emanating ‘please call or text me for I want to hear from you” must have been damaged while under the influence of the ketamine. 

I hope to feel better after I’ve slept and had a few real meals. I have two days to cheer up before Brother #4 arrives. Hector the yard man comes on Wednesday to tidy up the weeds that have grown quick as triffids in the recent rains. The house is as clean as it has been in a long while; I’m half-tempted to cancel on them jus to keep things tidy for as long as possible.

I was glad to get caught up with blog reads and see nearly  everyone is doing well enough.  

Hopefully tomorrow will be better.

 

*For thems interested: it went OK. 

medical_cupcakes

The colonoscopy preparation instructions say I am not to eat anything for these next 24 hours, nor am I to drink fluids that are red or purple. I am presently consuming tea (hot and cold) and bright blue and yellow sports drinks. I am working in the yard; I’ve taken some allergy medication. Zylert on an empty stomach has left me tired and buzzed – almost intoxicated.  Curiously I don’t feel too hungry. During the breaks from the chores I thought to go online but food is everywhere: Facebook, blogs, pop up ads you name it, it has food mentioned. This may be a case of ‘Baader-Meinhof’; I want something to eat so I am noticing things I don’t normally see when surf the web. 

Someone is washing the windows while I tend the back yard. I am throwing out the dead plants and replenishing them with herbs and succulents recently bought at HomeDepot.  We are getting the place decent for Brother #3 and family who arrive this Wednesday.  The hot tub – unused for months – has a green tint to it making it unwholesome so it’s being drained at the moment. Last week I gave instructions to the pool man to pay extra attention to the pool. We usually don’t set foot in the cement pond until Memorial Day but Brother #3 is bound to want to go in it. He lives in Michigan and has antifreeze for plasma.

I hope we have things decent in time for their arrival. I have my ‘scope tomorrow morning at 7AM then I have the rest of the day off. I am hoping to spend the day  continuing the tidy up but I suspect I will sleep the entire day away. I’m supposed to raise at 245AM to drink large amounts of nasty concoctions so I’m not going to get any sleep. I will look a fright when I see the GI doctor but then again he will be more concerned with the other end of me. 

“Well that was a real downer” read this morning’s email from The Board of Directors Here at Spo-Reflections. They took umbrage at yesterday’s entry. Apparently they interpreted as literal truth my metaphor about the CEO with an unruly board of directors in need of careful monitoring. Sensing a hostile takeover of a rival board (probably the Picts) they held an emergency board meeting in which it was unanimously voted to burn down the board room. As a consequence I am writing this from my work place.

21 March is the birthday of J.S. Bach, composer extraordinaire and overall stud. In celebration of the day at work I was playing fugues and cantatas . My administrative assistant, who is in his 20s, asked what I was listening to. I explained. He looked at me in that nice way underlines do when they are being too polite to admit they haven’t a clue what you are talking about.  Oh the horror. I explained who was Herr Bach.  Later on I pointed out to him Google’s headline was in the shape of Bach playing the harpsichord – see I am not the only one who knows about him.

Last night I arranged a weekend trip in April to Michigan to visit Brother #3 and family. This gives me something to look forward to. Nothing is planned so far. I suppose I will spend some time playing games with the niblings. The Progenitors (A.K.A. Mother and Father) will probably feel a bit left out I am not visiting them so they will probably come up for a visit or vice versa. This will lead to other Spos coming by as well.  I do have a nicely knit family this way. I hope to see some daffodils I miss them so.

This week the electronic health records suddenly provided a means to drop templates into progress notes. Hot puppies indeed! This is a godsend.  Usually I have to cut and paste my own creations from Word into the notes. This new system is much quicker and more convenient.  Templates are a tricky thing as one must avoid merely repeating the same note over and over.  In health records this is how mistakes keep going and this is way bad in legal matters.  Even when the patient is more or less the same time after time I must make individual notes.  Often a note that says ‘everything is OK/same’ is more tricky than when things are happening.

 

Next Monday I go for a colonoscopy. I have patients (mostly men) so terrified of the procedure they have never had one. I don’t mind getting scoped but they are a nuisance. Taking time off and doing the prep are tedious matters for me. My ‘scope is about 3-4 years overdue this way.  Every time I have one of these I rue the day I didn’t go into a specialty with a billable medical procedure. What a racket these GI MDs have! My GI doctor is a nice man well over four feet. This nurse is a bit patronizing that she likes to ‘educate’. I politely remind her again I am not unfamiliar with anatomy despite being only a psychiatrist and not a proper doctor (no I don’t use those words).  I suspect in my chart I am down as a smartypants but apparently not down as a physician.

Spo-fans know I am trained in Jungian psychology; when I am work on self-awareness I explore such in the lexicon of complexes and archetypes.* I’ve noticed some sort of complex is beginning to dominate my mind. I’ve haven’t identified yet what it is or where it comes from; it is a work in progress. By writing this entry I hope to gain some insight as I write it out or from assistance via the comments.

This complex is going on the alleged axiom Life is over and what’s left is waiting for its end. Said complex is manifesting itself through warm thoughts and memories about my past. Lately I’ve been reading poetry and literature about older folks recalling their youthful experiences at life’s end. There is a sense of my body slowly falling apart and I am not worrying about it. The tunes I’ve been attracted to resonate with the complex: “Our Last Summer” by ABBA; “This Old House” by Stuart Hamblen and so forth. I have a sense of not wanting to travel, plan for the future, or do much self-care. After all, I’ve had a good life/done some things – and now it feels over. I am walking downhill into the sunset.

In summary: I am challenging an old man, somewhere in his mid to late 80s.

Ego wants to know what the devil is going on and where this is coming from and why it is appearing now.

First of all let me assure Spo-fans these feelings and actions aren’t stemming from apathy or weariness. This is not depression. I know a lot about depression and this isn’t that. My health is good, my job is going OK. I am enjoying activities.  Perhaps The Old Man Complex (as I just christened it) is coming from a sense of contentment viz. as everything is going OK why bother going on? The world seems to be going to pot and I am glad to be old enough to check out?  “Let some of the younger ones deal with it” I hear him/it saying about Life’s matters.

I don’t remember ever having this before. I’ve had times when I thought “life is over” but I was not happy about it, nor did I covert it (nor was even closely correct). I’ve been content before but this didn’t elicit a ‘games over’ emotion.

Curious indeed.

Happily I have enough Ego/consciousness to smell a rat. There is nothing wrong resting in a golden nidus and watching the sun set. This doesn’t groove however as I am in my mid-50s. This Complex /Ego situation reminds me of the scene in Monty Python and The Holy Grail of the man exclaiming “I’m not dead! I don’t want to go on the cart! I feel happy, happy!”  I can not succumb to the Complex saying ‘No you’re not! You’ll be stone dead in a moment”.

So I’ve identified a problem. I don’t know yet ‘why’ it’s there but I’ve identified it as can keep tabs on it.  If you hear I’ve quit work/Life  please bitch slap me.

 

*For thems in need of a quick Jung 101 lesson: imagine your conscious self as the CEO at  a table with many diverse board members. You/Ego get input into the many members that make up the board that is your psyche. The members vary in how much they say and how bossy they are; they vary in their influence as well. Sometimes one or a group of them want to take over and be the Ego; they want to be in charge. A good conscious Ego is aware of all of them and their positive and negative attributes; you recognize when and which ones are ‘speaking’. It is the role of the Ego to take in all information and opinions of the Complexes in but in the end Ego- CEO-conscious self makes the decisions. It is in charge – not the complexes. This takes constant self-awareness. Phew.

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The Other Doctor (TOD) and I have different approaches when it comes to seeing patients who are associated with existing patients. If TOD has “X” for a patient, he will not see X’s spouse, children, siblings, etc. Even distant relatives are declined.  I take the opposite approach:  I subscribe to the ‘Family Physician” style of shrinkdom in which the doctor sees relations to appreciate all that’s happening at home, work, and family.

My style as a drawback I have to retain patient confidentiality. This is no small task. I have to remember who said what. Mr. R sometimes asks me will I see their spouse, child, parent, coworker, or friend. This is a compliment as he must feel good about my services to ask me for such. I explain yes I am willing but on the agreement despite my attempts to keep boundaries inevitably I will bungle.  I give an example of asking Mr. R about so-and-so only to see him raising his eyebrows and asking me how do I know about so-and-so as he hasn’t ever brought it up. Inside (I explain) I am thinking “Drat, it was Mrs. R who told me that”.  If Mr. and Mrs. R don’t mind these human mistakes then make it so.  I don’t remember a time when this dissuaded them from both seeing me.

Getting different views and perceptions of what’s happening can be curious. The missus comes in with remonstrations about the mister. A few weeks later when I see the mister I ask how are things at home he replies oh everything is fine really no matters.  Is one of them ‘right’ and the other ‘wrong’? Are both ‘true’ from a subjective point of view? I have to maneuver around these Roshoman moments all the time.

The ‘family practice’ style of psychiatry has a harder issue than merely keeping tabs on who gave me what or different points of views. I wrestle with ‘secrets’ the other one doesn’t know but ought to. The Other Doctor doesn’t have to contend with these matters, which is probably why he does not do the family practice approach. Recently I had a new patient who was horribly depressed in his relationship. He felt stifled to speak up his partner about the many miseries in their marriage. A few days later I saw his partner who remonstrated his partner the new patient is depressed but he can’t figure out why when all is so well at home and they are groovy.  I remember a case I saw the mister who was having hook ups unbeknownst to his wife my other patient.  Do I tell her?  I am allowed to break patient confidentiality if there is an immediate threat to self or others. If someone says they plan on killing themselves this weekend but don’t tell anyone you bet your knickers I am going to call someone. However what if they are voicing thoughts of suicide without immediate plans or intent and the spouse doesn’t know. That’s not as clear.

As for complaints about the other, I often sense A is telling me things as A doesn’t trust B is forthcoming with me. I try to get A’s permission for me to talk to B. When they so no, I point out how the heck am I supposed to bring up something?  Often I have to find some way of discussing a topic with B without letting on I know the scoop because A said so. Once in a while B smells a rat; I remind B this happens when A and B see the same shrink.

You would think these matters would be enough for me to take TOD approach. I too should tell folks I won’t see their friends, family, and coworkers – but they don’t. The benefits of seeing the bigger picture outweigh the drawbacks.

Ikigai

Patience above! The Board of Directors Here at Spo-Reflections are getting into Ikigai!

Once in awhile some door-to-door person foolishly drops by their fortress A.K.A. The Boardroom, hoping to sell them something. Normally these unfortunates are butchered or sold downriver* but last weekend one of these villains somehow got in and out with their digits intact AND they planted a flea in their archetypal ears.  Ikigai (I look up) is a sort of Japanese philosophy  about ‘your reason for living” or that which makes ones life worthwhile. I am just beginning to study this myself, so I am hardly an expert but I think this is just another way of saying having meaning in your life. Ikigai has four components:

Things we love

Things we are good at doing

Something the world needs

Having enough money to get by

If you have all four then you have Ikigai, a sense of contentment in your lot in life . You enjoy what you do/are and you are good at what you do. What you do benefit others and you have enough resources (money or otherwise) to sustain it.

Do I have Ikigai? Let’s see:

Despite some faults (what job doesn’t) I am glad to be a physician particularly a psychiatrist. I am not one of the alleged burned-out docs. I wake to be glad to go to work.

I am good at what I do, or so I hope. I think I get enough positive feedback from others to support my self-evaluation I do a good job.

Something the world needs? Indeed. When you earn a living through human illness and suffering there is no lack of need

Yes, I am paid OK. Compared to my fellow wizards my salary is on the low-end of the scale but it is more than most folks I am told. I really try not to compare it to others but to my own yardstick is it enough. Yes it is.

So I suppose I have good reason for living and my work is meaningful. That’s a nice feeling.

Meanwhile I get to see what TBDHSR is going to do with this alleged insight. They love what they do (pillage and rapine) and admittedly they are very good at it. From what I can tell it pays very well. They seem short on the fourth item: “something the world needs”. I will see how far they go on this before they return to their unflappable ways. Last time they dabbled in philosophy was after two LDS missionaries showed up.  “We understand Mormonism (they explained to me afterwards) we have eaten the missionaries”.  Sometimes they are quite sensible.

 

 

*Mormons and JWs fare worse: they are invited in then barred exit and forced to clean the bathroom.

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