Now Reading

Shelby Foote, The Civil War

Herman Melville, Moby-Dick, or the Whale

Michael Punke, The Revenant

Bill Bryson, Notes from a Small Island



The contents of this website are for contemplative purposes only. No medical advice will be given, and emails asking for medical advice will be ignored.

Although patient vignettes are based on my experiences with real individuals, I liberally change details to maintain patient confidentiality.

I also reserve the right to change old postings to correct errors, and to delete comments that include obscene language or that I deem abusive to me or other commentators.  If you are looking for a open mind, I suggest you consult a neurosurgeon.

Katrina Blog Project

The Rottweiler Effect

A friend of mine and critic of Donald Trump recently asked me why Trump’s supporters still support him, in spite of everything he has done. (And if you don’t think Trump has done anything reprehensible yet, please stop here. This article is not for you.)

My response was, “It’s simple. It’s the Rottweiler effect.” Let me explain. A person who owns a fierce, frightening, 120 pound attack dog thinks his dog is a good boy. He likes his dog because the dog protects him, loves him, and is prepared to rip the arm off anyone who tries to harm his master. The dog may growl at the neighbors and the mailman. The owner finds this funny. The dog is on his side, and the owner doesn’t trust the neighbors (or the U.S.Postal Service) anyway. Everything is right and good in the world.

Until the Rottweiler turns on him. When his 120 pound mauling machine decides he doesn’t love his owner anymore, all those bags of dog food and baths and petting and going out for walks lose their meaning.

A Rottweiler is a good as long as it is your Rottweiler and growls at the neighbors instead of you.

The Rottweiler efffect can be summed up this way: A Rottweiler is a good dog as long as it remains my dog. It becomes a bad dog when it answers to the neighbors.

The Rottweiler effect comes into play when people support a morally questionable person as long as that person benefits them, and cry foul when the same person turns against them later. It occurs because people prioritize results over good behavior. They want cheap gas, and don’t worry if we went to war to get it. They want free access to guns, and don’t worry what will happen if the wrong people get them, too. They want TV news they can agree with, truthful or not, and don’t care if the lack of truth in pleasant TV hurts anyone. They want a tax cut as long as it means somebody else's kids will have to go to a worse school, or somebody else's car is damaged by a pothole.

But to be like that is to play directly into the hands of evil. Satan never tempts anyone by saying, “Come on down to hell! You’ll love our eternal tormenting fires!” Instead, he says, “Let’s see if I can get you what you want first.” Once the tempted person gets what he wants, the devil gets his.

Put in more secular language, evil people first promise the world before they take it away.

The Rottweiler is easily identified. He promises you everything for no cost. He identifies the enemy and, after carefully assuring you that you are not one of them, brutally savages them. The owner/victim allows the dog to do what it wants, because it never occurs to him that the dog, once accustomed to savagery, might one day decide to turn its teeth on the hand that feeds it.

The Rottweiler effect is coming to a town near you. In fact, it has already been in your town for a long time. If you don’t want the Rottweiler turning on you, here’s some advice: Don’t feed him. No matter what he promises, don’t let someone who is unscrupulous be your protector or champion. Anything a bad person can do to your enemies, he can do to you.


Why Mental Health Reform Is the Wrong Way to Deal with Mass Shootings

America has a mass shooting problem. That is obvious to almost everyone, with the exception of a group of gun enthusiasts who seem to think we have a mental health problem instead.

The first time I heard mental health reform proposed as a solution to gun violence, I was encouraged. The compassionate care of the mentally ill has the potential to reduce crime, and even if it doesn’t, it will still help people who desperately need psychological treatment.

America has a dreadful mental health system. As bad as our healthcare system is (and it is pretty awful), mental health is worse. Mental health in the U.S. is plagued by underfunding, by non-coverage from insurance companies, and by government agencies that are poorly managed and neglected. No other sector of the American health care system is asked to do so much with so little. Mental health is further hampered by the criminal justice system, which takes some of the mentally ill off the streets and, rather than treating them, locks them up at great expense, only to release them years later in far worse condition.

If America built mental health facilities as fast as it constructs new prisons, our country would be a much better place. Instead, we keep building prisons, and cutting funding for mental health.

The idea of using mental health to prevent mass murder sounds good. A lot of mass shootings seem to be caused by mentally deranged individuals — the recent Florida shooter and the Sandy Hook murderer were two such examples. Perhaps, if these people had gotten better mental health care, the crimes might have been prevented.

But here is the problem: Most politicians, when they talk about using psychiatric services to prevent gun violence, seem to be talking about identifying the mentally ill and putting them on lists to prevent them from buying guns. This isn’t treating mentally ill individuals. It is using the mental health system to find dangerous people and turn them over to the government.

It is not, nor should it ever be, the job of medical personnel to help the government identify criminals. I am a doctor, not a police officer, and I am not comfortable with sharing my knowledge about a patient with the government. People come to doctors, and especially to psychiatrists and psychologists, with the expectation of confidentiality.

Would you see a doctor, knowing the doctor is encouraged by the government to notify the FBI if he finds you suspicious? Far from preventing crime, policy that violates patient confidentiality is likely to result in less mental health, not more, and will therefore increase crime. Patients most in need of help will avoid care at all costs to avoid being turned in.

Every year, I have to fill out a set of forms to continue to receive malpractice insurance in the State of Mississippi. I am asked a variety of security questions, such as if I have been arrested or accused of a crime, if I have substance abuse issues, or if I have been disciplined by a medical staff for misconduct. And I am asked if I have been treated by a mental health professional for anything. Depression, anxiety, marriage difficulties, anything whatsoever. And if I have, I have to get my therapist to write a letter explaining why it is still safe for me to practice medicine.

This always bothered me. While there are some mental health issues, such as substance abuse, that probably are the business of my malpractice carrier, treatment for depression or anxiety is not. If I am seeking help for a psychological problem, that is a good thing. Better to be under the care of a psychologist and practicing medicine than seriously depressed and practicing unsupervised.

The questionnaire does not ask if I have a medical problem that could affect my ability to practice. There are numerous medical conditions — cancer, seizures, chronic pain, Parkinson’s disease — that could have a serious impact on my ability to practice medicine. I could have Alzheimer’s disease, for example. But my insurance company is unconcerned about that. Only if I have a mental illness do I have to have a letter clearing me to practice medicine.

This is what stigmatizing psychological disorders looks like. Somehow, a mental disorder is seen as worse, and more important to single out, than any other medical condition that might afflict a doctor. Given this prejudice, a doctor with a serious psychological disorder would be less likely to seek out psychological help, knowing that he would have to report it to his malpractice insurer, and possibly be told he cannot practice medicine any longer.

This problem is similar to the situation of a mentally ill individual who is reported to the FBI. This person might then have to worry about being able to work for the government or about getting security clearance for a job. He or she might not be able to serve in the military, or on a police force. And because people who travel in certain areas of the world often have to pass security screenings to get back into the United States, a person on a no-gun list might even have trouble traveling abroad.

While it is true that many people who commit mass shootings are mentally ill, it is not true that most mentally ill commit mass shootings. Think of it this way: All sharks are fish. But that doesn’t mean that all fish pose a danger to humans. In fact, not even all sharks attack humans — of the 375 known shark species, only three — the great white, the tiger, and the bull shark — attack humans with any frequency.

In much the same way, it is unfair to blame the mentally ill for mass shootings. Very few people with psychological disorders commit violent crimes, and this is even true of serious mental disorders, such as schizophrenia or antisocial personality disorder. Singling out mentally ill people as dangerous is about as fair as killing all the fish to get rid of the sharks.

It is not clear how many mass shooters meet the criteria for mental illness. Nor is it clear which mental illnesses are most likely to lead to mass shootings. But mass shooters do have one thing in common. They use high-powered assault and semiautomatic weapons.

Seems to me the more obvious place to start is there.


The Day After More Murder: About Gun Control

This is a simple matter. As simple as it comes.

Any politician who cannot vote in favor of gun control in some form needs to be fired from his job.

I'm not asking for a blanket ban. Background checks, limits on bullet purchases, smaller magazine sizes, assault weapons bans, anything. Anything.

But if you are in elected office, and you can't do that after all this, you need to go. You aren't just a bad politician -- you are an accessory to mass murder.


...And a Comment about DACA

Yes, it is true that Dreamers are here "illegally," and that we are a nation of laws. And yes, it is true that a nation that cannot defend its laws is a nation without order. And yes, we need order.

But laws are man-made. People are gifts from God. When you ask me where our hearts should be, and where our laws should be, I say they should be in the service of gifts from God.

A country without people in it will never have a lawbreaker. People are an inconvenience for law -- people have needs, they are complicated, they demand exceptions to the rules, mercy, leniency. The simple answer is to get rid of the people, and then there will be no problems.

But what is a country without people worth?


The President and “His” Stock Market

Fewer and fewer people defend the President these days, but when they do, their main defense of his antics is that is that, cad as he may be, the stock market went up 25% last year. This notion of crediting the president for what the economy does always struck me as odd. While there is no doubt that a badly run nation can lead to a poor economy, it does not follow that a president exerts any control over the day-to-day movements of the economy at large, let alone the Dow Jones Industrial Average.

My own view, for what it is worth, is that presidential actions take years to impact the economy in a meaningful way. Businesses base hiring plans and expansion on revenue over the long run; only a complete idiot would say, “Hey, Congress cut taxes, let’s open 200 new stores and build a billion dollar manufacturing plant in Ohio.” It takes months, if not years, of proven growth before most businesses will make the decision to invest more money in expansion. That means most companies needed several years of growth under Obama before they would consider hiring new people under Trump. Businesspeople are conservative for a reason — they don’t like losing money on random movements in the economic numbers. They sit, they wait. They don’t gamble on who sits in the White House. It’s common sense.

But I also wonder, why do people think credit for economic growth goes to the president and not to the people who run the companies? I just bought an Instant Pot, a product that has been selling like hotcakes lately. I am pretty sure the company that makes Instant Pots deserves a lot more credit for building their business than any of the elected squatters in Washington, DC. If I were a businessman, I would be insulted that a politician would think to take credit for my business success. It would be no different than if the CEO of my hospital pranced into the room of one of my patients and tried to take credit for my good medicine. But I guess that’s just me. Seems that at least some business people these days are happy to let a politician who has been on the job for a year claim the credit for something they worked hard to accomplish.

Imagine that you have a bad knee and go to see an orthopedist. The orthopedist tells you that you are a fat lazy slob and you need to lose weight to make the knee pain go away. So you go home, get on a diet, lose 50 pounds and start running 10K races. Then you tell all your friends your orthopedist is the best doctor in the world.

You can do that if you want, but you’re a fool if you do. All the doctor did is insult you. You did everything else. Stop letting politicians take credit for the economy; they don’t do anything but stand on the sidelines. You are the one playing the game.