Docsplainin' -- it's what I do

Docsplainin'--it's what I do.
After all, I'm a doc, aren't I?

Saturday, November 15, 2008

On Fairness and Respect

Sister blogger Lesboprof is out protesting California's Proposition 8 this weekend. She explains in today's post that the nationwide protests are about a lot more than "gay marriage":
It is about calling out people's rejection of LGBT people... the idea that you can say you love us individually and vote against us as a group. We are your family members, your teachers, your students, your friends, your neighbors, your partners in faith, your elected officials, and your compatriots. We deserve fairness and respect.
She's right. That vote was an awfully painful slap in the face to LGBT people everywhere, not just in California. The message is that however much it may feel like you are accepted and respected by society, you really aren't. It's all lip service. And when your students, your friends, your neighbors, your family, and your fellow congregants can vote in secret, the truth comes out. A vote like California's serves only to demonstrate straights' hate and disgust and fear. And that is what it is. During the Civil Rights era, you used to always hear "Some of my best friends are Negroes, but..." and then would follow some right or list of rights that Blacks should be denied. Despite what people say about not being racist or homophobic or sexist or whatever, their behaviors say otherwise.

Maybe we ought to reserve the term "marriage" for the religious ceremony that takes place in churches, synagogues, and other houses of worship. Maybe we ought legally to refer to it as "partnership" (with some adjective to distinguish it from a business license) and make it accessible to everybody (adult), everywhere. The official status of what we currently call "marriage" confers not only numerous legal and financial benefits--which there's really no logical reason to deny LGBT people--but also a certain social standing and psychological meaning. When your coupleship is official, it gets much more "glue": Other couples support it, singles respect it (by which I mean it cuts down considerably on "poaching"). A state license grants a personal sense of permanence, stability, and trust in the relationship--that it really means something, that it will be there for you. All of which there's also really no logical reason to deny LGBT people.

When I was growing up, it was illegal for people of different races to pair off, never mind marry each other. It was called "miscegenation," and it was a crime. There were laws against it. (I know I just said the same thing three times, but I'm betting there's young people out there reading this who won't believe me the first time.) That looks so quaint, backwards, racist, and downright silly to us now. Why are we holding on to the same ugliness with regard to LGBT people? It does not become us as a nation. What it says about "the content of our character" is not pretty.

It's time we grew up.

Thursday, November 13, 2008

Courtroom Antics

I have two cases going to court in the next couple of weeks, one civil and one criminal. And it's got me to thinking about past forays into the justice system and how weird it can get.

Used to be, we were the only private practice up here for miles around, and we had folks drive from as far north as Dalton and Copper Hill for therapy. As a result, we were occasionally in courtrooms just about anywhere in the Blue Ridge circuit. Judges and attorneys varied wildly in quality. On one memorable occasion, I drove all the way up to Calhoun to testify in a divorce case in which I had already warned both parties that I had nothing to say that would be good for either of them. But one of them subpoenaed me anyway, so off I went at the crack of dawn to the wilds of north Georgia. No sooner had I been sworn in than the judge asked me if I wanted to waive privilege. I said "No," he excused me, and that was that.

Now I am no lawyer, but it is my understanding that, in the first place, the privilege is not mine to waive. It is the client's, and the soon-to-be-ex-wife, by subpoenaing me, had already waived hers. (Not to mention that, under Georgia law at the time, communications with me weren't privileged in the first place.) But whatever. I didn't want to be there so this suited me just fine.

Even some counties close in to Atlanta were pretty back-country when I started my practice. I was in Dallas one day for a child sexual abuse case. This Court liked to assemble all the parties, including witnesses, before beginning trial and was calling roll. The child victim was female, and was accompanied by her mother. The mother had brought her divorce attorney, who was female, as there was also a modification of custody action pending. I'm a woman, of course, as was the pediatrician who was going to testify to some physical evidence. A female police officer was there to testify as well. At about this point in his roll call, the judge, clearly exasperated, turned to the (female) ADA and asked, "Is everybody in this case female?" to which the ADA, straight-faced, replied, "No, Your Honor, the Defendant is a man." The courtroom broke up. Even the bailiff was laughing.

Tuesday, November 11, 2008

Veterans' Day

For those of you who like to write but are occasionally stumped for a topic, check out The One Minute Writer. Today's prompt, appropriately enough, is "write about a war veteran you have known of, or known personally."

The first vet I ever knew was my Mom's Dad, whom we called Boppa. He was in the infantry in World War I. I don't know much about his service, because he had a repertoire of three funny stories and that's all he would ever say on the subject. My father-in-law was in the Navy (Pacific) in World War II and was reportedly much damaged by the experience.

One of the best clinical supervisors I ever had served two tours in the infantry in Viet Nam before he went to medical school. As a therapist, it has been my honor to work with veterans as well as active duty personnel and military families. Some have seen combat, others have not, Some were officers, others grunts or noncoms.

Today, and every day, I would like to thank them all for their service.

Wednesday, November 5, 2008

One of my students told me today that I already had a good rating on RateMyProfessor. This surprised me, as I have only been back teaching since January. But I went to look tonight, and sure enough, there I was.

There's good news, and bad.

One of the ratings was from 2002: "Awesome. Really knows her stuff, makes it interesting." I got good ratings on helpfulness. Unfortunately, I'm also rated as "easy". (I'm not easy: I flunked somebody last Spring, fer cryin' out loud!) So of course my overall ratings were good.

But the worst part, worse even than being described as "easy", was that I got zeroes on "hotness". Now I realize that at 56 I can't look very hot to most of my students. But zeroes?

Tuesday, November 4, 2008

Obama wins!

"Change has come to America."

Saturday, November 1, 2008

The Mental Status Exam

MDOD has a new post, complete with CT scan, on a fella who came into ER c/o (complaining of) altered mental status. Of course in the outpatient private practice of clinical psychology, one rarely--if ever-- sees such dramatic cases. Nevertheless, it's a good reminder that whenever we do see a really whack MSE (Mental Status Exam) we should always, always have the patient seen by a physician to rule out physical causes before we assume that they are "just" being paranoid, or are schizophrenic or whatever. Talk therapy won't work on tumors.

Mom once lost a friend that way: He'd been in treatment for months for "depression" when what he actually had was a brain tumor. This happened when I was still an undergrad (yeah, yeah, I know--back before the Flood), but it's remained in the forefront of my mind whenever I am doing an initial assessment or when an ongoing patient's status changes. Mom's friend had never been depressed before, even though he was by that time in middle age, and there was no family history of it. Furthermore, there were no apparent environmental causes (e.g., illness or death in the family, work stress, etc.). Which should have been big ol' red flags right there.

In a practice like mine what we are more likely to see is someone who is physically quite ill, but the medical folks, having failed to find the cause, refer them to us for psychotherapy for imaginary or manufactured illness. One such fella I had certainly had an altered mental status--he kept passing out!--but there was no discernible psychosocial causation, no family history of anything remotely similar, and his personality profile from psychological testing was completely inconsistent with any sort of histrionic or psychosomatic disorder. And a friend's son was once referred to a psychiatrist before it was finally discovered that he really was having trouble breathing: The poor kid had tuberculosis!

Point being, I guess, that mistakes get made on both sides of the professional aisle. Medical people should listen to us when we tell them we don't think the problem is psychological, and we must consult with them, too.