Wednesday, March 19, 2008

Informal Poll

I would like to conduct an informal poll of everyone out there. This is the question: Are you more of a Thinker, a Talker, or a Doer? Leave a comment or an email with these three attributes ordered from most to least. (Naturally, I will make a pie-chart of the results and report back.)

Having trouble deciding? Here are some queries to help you reach a conclusion. Do you think before you do? Do you tend to talk about what you're going to do, then talk about what you've done-- or do you think about what you're going to do, then think about what you've done? Do you do things that no one else knows you're going to do ahead of time? Do you yourself even know what you're going to do ahead of time? Do you spend more time talking about what you've been thinking about, or thinking about what you've talked about? If you do something but can't tell someone about it, is that a problem? If you think something, is it more important to do something about it, or to tell someone about it? If you talk about something with someone, is it more likely to lead you to do something, to think something, or to talk more about it with someone else? Is thinking about this right now driving you nutty, because you'd rather be doing something? Would it be better if we sat down for a drink and talked about it?

Monday, March 17, 2008

Creativity In Psychiatry, I

Partly, I went into psychiatry because it seemed like the most creative of the medical specialties. I enjoy employing my imagination, and my clients'. I like trying creative therapeutic "prescriptions".

One of my current clients had been on high doses of both a stimulant and a sedative, prescribed by his previous psychiatrist. He was confused, anxious, and having memory problems. Over the course of several months, I tapered down both medications, with positive results on his mental state. We got him off the sedative altogether, and got the stimulant down to just one dose first thing in the morning-- but he couldn't seem to give up that last pill. "I can't get out of bed without it", he said. "I leave it on my nightstand with a glass of water, and I take it when I wake up, and 15 minutes later I have enough energy to get out of bed. If I don't take it, I just roll around in bed, but I can't get up. I really need it to get going." I didn't argue with him. I said, "I absolutely agree that you that you can't get going without the stimulant. You need to have it. But you are wrong about being unable to get out of bed without it." He protested that in over a year he had never been able to get out of bed without taking the medication first. I said, "You've told me that you roll around in bed before you take the medication. To get out of bed, all you need to do is roll in one direction until you fall out of bed. It's possible that you can't stand up without the medication, but you can certainly get out of bed. So here's what I want you to do: Put the pill and your water on the floor near your bed, but just out of reach. When you wake up, roll till you fall out of bed onto the floor, then reach for the medication and take it. You won't have the energy to do anything else for 15 minutes until the medication kicks in. So just lie there on the floor until it does. Or if you get a little energy after a few minutes, you can get back in bed while you wait for the full effect, then get up. Until you try this, I can't believe what you're telling me about being unable to get out of bed."

He thought this was kind of crazy. He didn't like the idea of lying on the floor for a quarter of an hour in the morning, and put off implementing my "prescription" for almost a month. But eventually he tried it. He reported that on the first day he rolled over to fall out of bed, but it felt "silly", so he just stood up to reach his pill. While he was up he also went to the bathroom, then went back to bed to "wait for the pill to work". On the second day he did the same, but something distracted him while returning from the bathroom, and he didn't make it back to the bed. After the third day he stopped the pill altogether, and hasn't taken one since. (He was so unsure that he could survive without the stimulant that he took No-Doz for a few more days, but finding this gave him horrible jitters he quit that too.)

It was a good plan, I think. Coming later: Creativity II.

Sunday, March 16, 2008

Smallish City Late-Winter Anthems

It's a really nasty mess around the Smallish City. Or Schity, as I have taken to calling it, due to the rapidly revealing crimes of sociopathic dog owners who have been letting their puppies crap on snow banks all winter without picking up after them. Anyway, it's just grim. All winter things get progressively dirtier, the infrastructure progressively crumbles... the darkest hour, so to speak, is just before dawn/spring. And you start to wonder if things will ever get lovely again.

Lying awake in the grey dawn, I composed a couple lyrical alterations to form Smallish City Late-Winter Anthems. You probably know the tunes. Come, sing along!

Of thee I sing, Schity!
Winter winter winter (spring?), Schity!
You're my frozen trash heap,
You're my road salt stew;
There's a weak sun melting
Your frozen doggie doo.

Of thee I sing, Schity!
You have got that icy thing, Schity!
Slush pools at clogged sewer grates,
Worthy of a Smallish State-
Of thee I sing!

My Schity, 'tis of thee,
Froze'd banks of doggie pee,
Of thee I sing;
Land where my batt'ry died,
Potholes on every side,
Frost heaves your wheels' demise
Let freedom ring!

My native Schity, thee,
Land of the road sand scree,
Thy view I loathe.
I curse thy rocks and grime,
Thy bitter black ice rime;
I'll say it just one time:
Spring better come.

Saturday, March 15, 2008

Vive La Difference (Un Petit Peut Seulment, S'il Vous Plait)

Something a client said the other day, that just seems to sum it all up:

"I hate to think that God put us all here to live by ourselves and be lonely. But if that wasn't the plan, why did he make us all so fucking different and impossible to get along with?"

Quand Vous Etes En Colere Et Vous N'allez Plus Accepte Ca

Sometimes you say to yourself about a situation, "I just can't tolerate this any longer." But then a week (or a day, or a minute) later you find that, in fact, you did tolerate it longer. Then you are forced to say to yourself, "I was wrong. I was able to tolerate it longer." Which implies that you might be able to tolerate it still further into the future. Which, when you realize it, is a sort of strength.

But the question always remains: Should you tolerate it, just because you can?

Friday, March 14, 2008

New Fee Schedule

I am thinking of revising my private practice fee schedule. In addition to my usual rates for new evaluations, hour and half-hour follow-ups, cancellations, and no-shows, I may add a special fee for "If you run out of my office manic and psychotic and I have to chase you down three flights of stairs and across two city blocks, including pausing and pretending I don't know you for a minute while you try to buy cigarettes off strangers, and then coax you back to the office before you get yourself into serious trouble."

Because really, I should have been paid a bit extra for that. Don't you think?

Rough Day At The Office?

I went to use the men's room on our office floor at the end of the day yesterday and found a guy in there pounding tall boy cans of Old Milwaukee. He had one on the sink and there were four empties in the trash can.

After ascertaining that he isn't a client of any of my colleagues, my guess is that he is someone who comes in off the street to "borrow" our restroom for his drinking (there have been two other occasions when I could've sworn the bathroom smelled like beer, but found no hard evidence.) Needless to say, we're going to get the lock on the door fixed.

Tuesday, March 11, 2008

Unusual Sight In The Smallish State

Back in the days when I lived in Philadelphia, Boston, and NYC, I took no notice of Porsches and Jaguars on the street. They were a dime a dozen, so to speak. Ferraris, Maseratis, and Lamboghinis were a bit less numerous, but still more or less a daily sight. The occasional Rolls Royce or Bentley merited a moment of admiration, but that's about it. You'd never interrupt your dinner companion to alert him that a Rolls had just driven past the restaurant.

Here in the Smallish State, it's not like that. It's pretty rare to see a car with a pricetag over $50,000. So I was a bit shocked, walking back from the sandwich shop just now, to see a man getting out of a Maybach 57. He was in front of one of the nicer hotels in town, and appeared to be handing the keys to the valet.

This car is worth more than my house, boat, Subaru, and kidneys put together. Retail price seems to be about $350,000. What on earth is it doing in the Smallish City? Does its owner not notice that our streets are currently an ungodly dangerous mess of potholes, glare ice, rock salt, sand tornadoes, and sea spray? He would be wise to take his precious machine back to Massachusetts before some ill befalls it...

Wednesday, March 05, 2008


Walks to work in slush
Asleep, dreams of crocuses
Why stay awake now?

Monday, March 03, 2008

Smallish Numbers

So I was sitting on the beach down at Tropical Island Paradise last week with the family, watching the pitiful little six-inch tropical tide, and thinking about our more he-man sized tides back here in the Smallish State. It occurred to me that, with the longest coastline in the Lower 48, and the highest tides, The S. State must may have the most variable surface area of all the states. Which observation of course leads to the question: how much bigger is the Smallish State at low tide, compared to high tide? Does it add appreciably to our area when the tide is down?

There are some challenging variables to guess at in coming up with an estimated answer. First: how much coastline does the S.S. actually have? According to the state website, “over 5,000 miles”, if you include all the islands, which of course we will. Next: what is the average tidal rise & fall of the entire coastline? Hard to say exactly, but the tide does vary somewhat linearly along the coast—from an average of about 9ft at the southwest border, to an average of about 19ft at the northeast tip. So as a rough average of averages, let’s call it 14 feet. Now the haziest factor: in order to decide what width of beach/rock/mud/lobster is exposed when the tide goes down 14 vertical feet, you need first to guess at the average angle that the shore slopes off into the ocean. In some places, it’s virtually vertical (on Sandra Lee, at times, we’ve been within 30ft of shore in 150ft of water.) In other places, like the southern beaches, it looks to be no more than 5 or 10 degrees of slope. In most places, though, I’d say you can cautiously wade out into the water up to your chin, without precipitously falling down an underwater ski-slope—which suggests to me that the average might be no more than 30 degrees. So, let’s call it that (anyone with better information, please comment.)

Now then. Trigonometry provides that the hypotenuse of a 30 degree right triangle will be twice as long as the short side opposite the 30 degree angle (sin30=0.5=opposite/hypotenuse.) So a 14ft vertical drop on a 30 deg sloping shore will unveil 28 feet of land. (Does this seem about right? At low tide, the distance from the water’s edge to the line of old driftwood, about five body lengths? Yes, I think so.) 28 feet is (28/5280=) .0053 miles. So along every mile of shore, (1mi x .0053mi=) .0053 square miles of land dries out each low tide. And there being 5,000 miles of coast, this totals (5000 x .0053=) 26.5 square miles uncovered at each low tide. Or 16,960 acres, which sounds a bit more impressive.

How much is this in relation to the Smallish State’s overall area? Pretty negligible, it turns out—the area of the state is over 3,000 square miles, so adding 26 doesn’t change much. But, the Smallish City, true to its name, occupies only 21 square miles. And we’d hate for those particular square miles to go under water twice a day.