"Now, in her afterlife, she occasionally accompanied Maggie on excursions into my head, usually at night. Make that a double vodka. I thought I had finally learned in sobriety how to put them in the past, encased in a box, and keep them there. Still, sometimes they found a way out to ...

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Patients deserve better. They lack access to and engagement with quality care — especially behavioral health care. Behavioral health goes beyond diagnosable mental health — everyone struggles with days that feel depressing or times that induce anxiety — you don’t need a prescription to know this. As of 2019, one in five Americans lived with a diagnosable behavioral health issue like anxiety or depression. That number skyrockets when you add ...

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"Our country, and the world, is beyond exhausted by COVID-19 and the utter chaos and destruction of lives it has caused. All people, including physicians, are being pushed beyond capacity. What do we mean, collateral damage? Originally related to war: the unintended result of a terrible, unprecedented event or action. We ...

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“Physician burnout” and “physician wellness” are now ubiquitous terms in the health care profession. For example, the ACGME’s common program requirements for residency now have an entire section dedicated to “well-being.” In addition to the numerous avenues currently available for physicians to improve their own wellness, I would also like to propose psychoanalysis as an option to consider by sharing my own journey as an analysand (person undergoing psychoanalysis) with ...

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“Those who cannot remember the past are condemned to repeat it” is a quote by George Santayana. It rings true in so many facets of life and medicine. In my career in psychiatry, I have held fast to this treatise. Psychiatry, as a practice, has changed over the years. We operate with the knowledge that we must always remember our past, especially since our past has been quite ...

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"While the rise in substance use disorders during COVID will become more apparent as the pandemic eventually ebbs, the silver lining is that this is not a novel problem. We understand substance use disorders far better than we understand COVID-19, and we also know that one of the largest obstacles to treatment is the shame associated with admitting that one has ...

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Doctors are often called “heroes” – a surprisingly uncomfortable label. Physicians are already tired of being held to a higher standard than the average person; raising the pedestal is problematic. While doctors are compassionate individuals who care about bettering lives and curing illnesses, we are also human. At the end of a standard workday, we would like to live normal lives. Unfortunately, the hours are longer, and we are never ...

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"We are social beings. Evolution has taught us that in order to survive, we must work together. Community trust (trusting your fellow citizen) is a very effective way to build community resilience when hardships strike. Studies have been done in the wake of natural disasters and have shown that social infrastructure and connections have equal, if not more, impact on the ...

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"Like 9/11, we have a new reference point touching everyone on the planet: life before COVID-19 and life after. Regardless if you get it or don’t, the unknowns and secondary consequences are scary. Life before COVID was scary, too, minus the urgency. Before COVID, we sensed the weight of living on a sick planet. We felt powerless to change the tide of ...

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I have worked part-time as an applied behavior analysis (ABA) therapist for the last few years. The job isn't complicated, and where I am, one doesn't need a specifically tailored education or license to practice under supervision. An ABA's clients are diagnosed with autism, and the therapist works to reduce the client's maladaptive behaviors and increase their comfort with everyday routines, social interactions, and independent living, all while taking data ...

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To know our history is to predict our future. We’ve been here before. To be more specific, we were in this very position in 1920. It was an election year amidst a pandemic, the Spanish flu that began in 1918. The Republican nominee, Warren Harding, claimed victory. Given the circumstances at the time, it is not difficult to imagine that what people are feeling now is akin to what people ...

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“Aunty blew her brains out a few weeks ago!” Words I shall never forget. For weeks, she had been in my thoughts. But I never called her. I didn’t because of all the myriad reasons we often give ourselves for not checking up on each other. In my case, they sounded like this; “I am 7 months pregnant, and it has been a difficult pregnancy.” “I am in an abusive marriage.” “My pediatric ...

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Unprecedented. How many times have we heard that word? Yet, here we balance between the life we knew and the life we long for with the deep, frightening chasm of the unknown strikingly in between. 2020 has not only been one for the history books; it has upended lives. The world economy crawls along, jobless numbers reach all-time highs, and families are finding themselves in a position where making ends ...

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Narcissism is a term that has roots in Greek mythology, and as the story goes, a nymph named Echo fell in love with a handsome young man named Narcissus, who loved nobody but himself. Echo had previously been cursed by a vengeful goddess who took from her the ability to form her own words. Thus, she was only able to repeat the words of others. One day Narcissus came across ...

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An excerpt from Medical Myths: A Sceptic's Journey. "Don’t go out tonight, ‘Cos it’s bound to change your life, There’s a Bad Moon on the Rise." - Creedence Clearwater Revival, August 1969 On a summer’s night on the St. Lawrence River, I have sometimes extended ...

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At a recent annual exam for one of us (Walter), the medical assistant had checked heart rate, blood pressure, temperature, and oxygen saturation. Inquiring cheerfully about the Fifth Vital Sign, she flashed the 10-point pain scale of emojis ranging from beaming to grimacing. The only mention-worthy pain was an occasionally aching meniscus from a forgettable high school football career. It was refreshing that she didn’t ask about burnout. Everyone else was. ...

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"I have been depressed. I have been burned out. I have been both. I have been neither. How do you know if you are depressed vs. burned out when your chief complaint is, “I feel like crap?” It’s time to call a consult. I don’t mean curbsiding your colleagues to fill your medications off the record without evaluation. I mean, ask for real help, from ...

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Brené Brown’s book, The Gifts of Imperfection, has recently been re-released with a new cover and subtitle: 10th Anniversary edition, Including New Tools to Make the Work Your Own.  I’ve had my original paperback copy for 8 years. It’s dog-eared, highlighted in three different colors, with lots of hot pink Post-It notes sticking out of all sides. Brené has published five other books, yet The Gifts of Imperfection continues to ...

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Have you ever watched a movie, television show, or read a book where the villain is a medical doctor? If you are a psychiatrist, you will be alarmed by how many times the villain in these stories turns out to be a psychiatrist. In all fairness, psychiatry has had its share of blunders. However, in recent years psychiatry has made a significant effort to enhance the use of evidence-based medicine ...

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I used to work with veterans who sought mental health care. Many developed PTSD after witnessing their comrades get injured, blown up, and die. Some of these veterans had visible wounds, as one would expect, but almost all of them had invisible wounds. The latter were worsened by survivor’s guilt or shame that they failed to protect their buddies or complete the mission. Many had guilt about getting med evac’d. ...

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