Friday, August 05, 2005

Out of Pysch: Out of Mind

On Monday I reported to the CT Veterans' Association hospital in West Haven (aka "the V.A.") for the start of my psychiatry rotation. It's quite a culture shock from Ob/Gyn. They didn't do much psychologizing (or psychiatrizing, as it were) on the obstetrics floors--my only real psychiatric experience there was listening to one of my residents tell a story about a woman who had given birth during her intern year: as the doctors swept Baby away to the bassinet to clean it up from its messy journey, the new mother had apparently looked on with fear in her eyes and became increasingly agitated. Finally, one of the doctors asked her what was wrong, and she asked anxiously, "Is my baby an alien?" Without exploring this bizarre speculation further, the medical team went into a flurry and quickly secured their patient into an inpatient psych which point a real psychiatric evaluation was done (i.e. a doctor actually took the time to sit down and talk to her about more than just her pain, vaginal fluids, and vital signs.) To the embarrassment of the obstetric team, it was discovered that the poor woman, a recent Mexican immigrant, had merely been trying to ascertain the citizenship status of her child! Oops.

It's been a little disconcerting, the sudden switch from an entirely female, largely under 35 patient population to an entirely male, largely over 65 patient population. Also, the switch from barely talking to my patients but probing deeply into their most intimate body parts, to barely touching my patients but probing deeply into their most intimate mental parts.

I guess the common factor on both is that they inspire me to do my own personal sort of probing--last month, thinking more seriously than I ever have before about my position on abortion: I always considered myself pro-choice by default since I consider myself a liberal democrat, but now after actually participating in terminations, prenatal care, and deliveries, I can say that I actively and unequivocally support a woman's right to make decisions about her own body.

Now, I'm thinking about the idea of insanity. I've read a lot of books in my day, but one of the novels that made the most impact on the way I think about the nature of society and reality was _1984_, which I read for the first time when I was in 7th or 8th grade. There was one line in that book that really hit me hard, and I still remember it to this day: "Insanity is a minority of one." I'm learning now how to do a comprehensive psychiatric interview, how to screen someone for things like depression, anxiety disorders, personality disorders, psychosis. A key feature I'm always supposed to be looking for as a sign of psychosis is thought content that seems "delusional." According to current consensus, a delusion is defined as "a fixed, false belief" that is not bound by culture or religion. But what if the culture believes something false? It seems to me that Copernicus and Galileo were clearly delusional, since they were essentially minorities of one in their own time. Doesn't every successful trendsetter or visionary have to go through a period of seeming delusion before others begin to agree with and catch on to their brand new idea? I'm not trying to deny that there are a lot of people out there suffering from disabling schizophrenia, because there are. But given the high correlation between certain mental illnesses and creative genius, and what I see as a ridiculous overuse and overdependence on psychoactive drugs by the medical profession...well, I don't know exactly, but I'm going to continue probing.

And finally, a new marketing idea from your favorite failed inventor (Danny Katz and I invented the Camelbak in 1990, long before it came on the market; we called it "water-to-go", made our prototype out of neon orange fabric, a hot water bottle, and the end of a fleet enema; it was entered into the NJ invention contest for children, and we didn't win; I'm convinced that the judges stole our idea, or maybe there was an EMS secret agent prowling about; I'm still bitter about the whole thing):
Alcoholism is, as you know, a huge problem in this country. One of the worst side effects, or sequelae, of chronic alcoholism, is a terrible encephalopathy due to the deficiency of the B-vitamin thiamine. Apparently, thiamine is an incredibly cheap vitamin, and is present in so many staple foods (bread and cereals, for example) that it's near impossible to acquire a deficiency in it unless you're truly not eating much of anything, which can happen when severe alcoholics replace almost all of their daily caloric intake with alcohol.

So it occurred to me today--why not supplement beer and other alcoholic beverages with thiamine? Or else start a new Budweiser campaign called "Bread--it's what's for dinner." There are enough bad things that end up happening to people with alcohol dependence; there's just no reason why we can't do something to help reduce this ridiculously easily preventable, yet potentially fatal, complication.


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