Mary is a woman of sixty years.  She is obese.  Originally from rural Alabama, she told me her aunt and uncle raised her, and they were bootleggers, making their own liquor.  By age fifteen, she was drinking this homemade hooch.   She never told me how she made her way to New York and New Jersey, where her kids now live, and where she once had a husband.  She is unsure ...

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"Being a parent in the middle of a pandemic is not easy. Sheltering in place with canceled daycare, school, and college, while also being a doctor or other healthcare worker, working in high-risk, high-intensity situations, presents many challenges.  It also presents many opportunities. It is possible to choose thoughts about being a physician and a parent during the COVID-19 situation that can ...

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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 may not be in a traditional war, but make no mistake, we are in a war. Imagine – you have ...

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The COVID-19 crisis has highlighted the dysfunction of our health care systems, from dramatic racial disparities in mortality rates to the abuses of health care workers. As a health care staff working on inpatient floors during the pandemic, the medical system's inequities have never been more clear — and they hurt the safety of both patients and health care workers. A few years ...

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"We know that the past two months haven’t been easy. We know about the sleepless nights, anger, tears, depression, and anxiety. We know all of this because we know what trauma does to a person, and you are in the middle of experiencing a repeated trauma. The trauma of watching patients die in ways you’ve never seen, the trauma of watching ...

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I have been drinking since I was 13 years old. I honestly didn’t realize that I had a problem until the last couple of years. The problem wasn’t so much that I drank in excess, or got in trouble at work, with the law, or with my family. The problem was that I couldn’t handle the full breadth of my emotions. Too much sadness, or even too much elation, was ...

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What are the challenges facing psychiatry? How does psychiatry need to innovate the continue to thrive? What is the future of psychiatry What's your #1 tip for those considering the profession? What advice can you give to primary care clinicians as it relates to behavioral health issues? Owen Muir is a psychiatrist and host of the podcast, Pandemic ...

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"I can't take this, doc. It's gonna kill me. I can't. I just can't," exclaims my patient with persistent refusal of his medication. My frustration is met with my patient care team's hesitation to give him the medication with fear of further conflict and possible escalation to violence.  But who's at fault? Any of us? All of us? My second patient, lying on the MRI table, shaking his head swiftly in ...

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"The unparalleled and pervasive nature of the evolving COVID-19 pandemic has touched all of us in some way. There is limited, albeit growing, research on the mental health effects of disasters.  A recent review article pointed out the potentially negative consequences of prolonged quarantine, while other research from Wuhan, China, highlighted the impact of COVID-19, particularly amongst healthcare personnel. Psychiatrists and mental health professionals will play a ...

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First and foremost, a mental health crisis is a medical emergency well within the sector of public health. Therefore, the question of who should respond to mental health emergencies is one in which physicians and all medical providers should have a say. Medical providers should not only be aware of the systems in place to respond to mental health crisis but must advocate for patient safety as a measurable outcome ...

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Debby Ann has a pit bull, and I remembered that when she called me recently.  It had belonged to her son, who is now deceased.  He was murdered.  She wants to meet me for lunch. Debby Ann is a pretty lady, at least she was the last time I saw her. We worked together for a while.  She has an especially pretty face, and nice blond hair.  In her twenties, I ...

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For as long as I could remember, I had always wanted to be a doctor. I used to destroy my younger sister's dolls, giving them incurable, permanent-marker-based diseases, surgically treating various ailments with craft scissors. The other earliest memory I have is of being told I had a few months to live at the age of five. I remember sitting in the surgeon's office, staring at the lucite paperweight on his ...

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Fear, despair, and exhaustion are emotions collectively expressed by health care workers during the COVID-19 pandemic. Years of health care experience has not equipped us with ways to maintain our mental wellbeing in the face of current pandemic, as evidenced by painful stories of fellow colleagues who have lost their lives. An especially vulnerable group among health care providers are Asians, who account for
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Patricia, she is maybe 40.  She is mentally ill.   Her mother was shot while cooking in her kitchen with a rifle someone was fooling with, and the weapon went off.  Patricia was there to see her mother’s head just about blown off.  She was 16 then. I don’t know why I mention the long-ago shooting, except it never goes far out of my mind when the subject is Patricia. Persons like Patricia ...

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This is the text of the keynote graduation speech given to the child and adolescent psychiatry residents at the Mount Sinai Hospital in New York City on June 18, 2020.

Let me begin by confessing that I am not a child psychiatrist.

I am an adult psychiatrist.

Or, as my mother says, I'm almost a real doctor.

One of the first things one learns as an ...

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Four years ago, after a blissful fourth year of medical school filled with carefully chosen psychiatry electives and plenty of hikes in the mountains, I began my psychiatry residency program. I started on sixteen straight weeks of medicine, and I was terrified. It had been months since my last medicine rotation. The fact that this had been by my own design was no comfort. I was so scared- of ...

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Work is a necessary part of life. More than simply a means to a paycheck, work gives individuals a sense of dignity and accomplishment. Feeling as though one is participating in meaningful work, whether it is contributing to a massive project or an individual artistic pursuit, allows one to feel as though they have a purpose. While this urge to create or work appears to be a universal human trait, the ...

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By profession, Donna Dillon is a photographer.  She wouldn't like to be described as a "professional" anything, but the quality of her photos make her deserving of the term. But disarray and inertia characterize Donna now, by her own description. "My life's work is stuffed into little places, and I sit relatively immobile, before the prospect of the bequeathment.  I have set up a will, but it is sort of desperate, ...

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I wake up in a cold sweat. It's 4 a.m. "Are you awake?" The text goes to one of my colleagues and best friends. I call him brother. He responds as calmly and kindly as he always does. "Sure, what's wrong?" I don't know where to begin. I feel stuck in a nightmare surrounded by drips filled with jet fuel, antibiotics, and sedatives.  I see the face of my most recent COVID-19 patient, fighting ...

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“Why is my disease less important than COVID?” Donna asked me toward the end of our phone call. Two years ago, after celebrating her 65th birthday, she was diagnosed with acute myeloid leukemia—an aggressive type of blood cancer—which turned out to be refractory to conventional chemotherapy. After spending hundreds of hours with doctors and social workers, she was scheduled to enroll in a clinical trial in May 2020. But COVID-19 postponed it. She is ...

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