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

To the Graduate, Any Graduate, Who Might Happen Here

This year marks the twenty-first year since I received my medical doctorate. Since then, I have not for one day regretted my undergraduate major in English and American Literature. As the years have gone by, my knowledge of literature has given me a resource to hedge against the way medicine is practiced today — that is, data-driven dehumanization. A humanities degree offers me perspective, the ability to empathize with the plight of the ill, and most of all the ability to communicate the concepts of science in a way patients and other professionals can understand.

To any student who wants to major in the humanities, I say go for it. (Or if you already went for it, congratulations.) The world of technical knowledge will always be there for you. You may be a bit behind your more technically trained colleagues when you start your post-graduate career (I was), but while you can close that gap, most of your colleagues will never make up for the loss of wisdom and human understanding, of empathy for others, of the ability to discern the truth, and thus of the ability to sniff out a lie and render it harmless.

Knowledge of life and culture is knowledge, too. It doesn't fill the wallet directly, at least not at first, but over the years those who truly study and learn the humanities discover that others who lack that grounding often ask for advice, and usually respect the wisdom given. Insight and clarity of thinking is like being physically strong. It is something you can achieve when you are young, and if you care for it properly it can be with you always, but if you don't acquire it young you will find it much harder to learn when you are older. It is knowledge that lasts.

Practical knowledge, on the other hand, has the shelf-life of raw salmon.


ONE FINAL NOTE: Everyone thinks to get accepted to medical school that you have to major in biology or chemsitry. I have heard this one, and heard it, and heard it, and heard it. Every guidance counselor I have ever talked to will tell you the truth, that you can major in anything you want to and still go to medical school. Counselors and medical schools try, but nobody listens -- it is like the myth that cold weather gives you pneumonia; there is not an ounce of truth to it, never has been, but the belief cannot be stamped out.

But I tell you, as someone who majored in English and went to medical school -- medical schools don't care what you major in! And majoring in the humanities does not hinder your medical education. I swear it's true, and I am living proof.


Et Tu, Morgan Freeman?


Even now, probably even after the many more revelations of sexual harassement I expect to hear in the future, I will still refuse to believe that all men, or even the majority of men, sexually harass women.

But I am starting to believe that in a society where fame and money is valued more than anything else, that the famous and the wealthy are so free of normal social constraints that the temptation to abuse and dominate women who are socially or professionally beneath them is irresistible.

As Plato suggested in his myth of Gyges, if a man finds himself in a position where he will never be held accountable for anything he does, he will not be able to resist becoming a monster.

As someone who is neither rich nor famous, I think I am happy that I am so.



Regarding the firing of the Chaplain of the House of Representatives

It appears that Father Patrick Conroy, S.J., Chaplain of the House of Representatives, was fired this past week because in November, during a daily House morning prayer ceremony, he asked that God allow tax reform legislation to benefit the poor as well as the rich. This seems to be unacceptable to Paul Ryan.

It used to be the position of most politicians that the purpose of the U.S. government was to benefit all citizens, not just the rich. There now seems to be a feeling among some politicians (Paul Ryan included) that America’s prosperity depends on the social innovations of the rich, and that it is the purpose of the government not to fairly help all citizens, but to help those who are most able to help themselves.

The result of this policy, or so I gather, is that the Job Creators (note how Godlike the word "creator" is, instead of the old word "employer") will in turn reflect this beneficence to the poor, who otherwise would become addicted to government handouts.

I find this political viewpoint ridiculous, but that is beside the point. The point is that Christianity, going all the way back to the Gospels, has always been about the poor benefiting at least as much from God’s grace as the rich. A quick reading of the Beatitudes (“blessed are the poor in spirit,” “blessed are the meek,” “blessed are they who weep and mourn,” "blessed are they who hunger and thirst”) confirms this.

It is mainline Christian thinking, near Catholic dogma, that the poor and suffering are to be the primary benefactors of the good works of the Church. To expect a Catholic priest to say otherwise is to expect him to commit heresy.

What Fr. Conway said is normal for any priest to say from any pulpit. It is only political if you are of the opinion that God rewards the good with extreme wealth, and curses the poor with suffering because they are lazy.

I don’t know for certain that this is Mr. Ryan’s opinion, but if it is, he is definitely not a Catholic. The Church, for all the problems it has had in recent years, does not need the help of politicians who think it is appropriate to repurpose Church social teaching for personal and political gain.


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.