Congratulations, Camel!

My shrink friend, Camel, is becoming an American citizen today.  Congratulations, Camel!

Roy is Driving Me Crazy!

I'm at my office today and I turn on my phone between patients. There's a text and a message, both from the same person. "Where is Roy, he's supposed to be here at a meeting? Can you contact him?"

Interesting. I scratch some body part or the other. Am I Roy's mother? Did someone forget to tell me? I forward the text to Roy, and welcome in the next patient. After that session, I check messages again. Roy has texted me, "I can't talk, I'm in a meeting." I guess he got there. Oh good.

And the blog. We have a rule about the sidebar: Dinah doesn't touch it. It's Roy's rule, but I've had a few problems, so mostly it's okay. But then, I decided I wanted a duck on the side bar. I put one up. That I can do. Roy took it down, because if I say Earth, Roy says Mars. Duck> No duck. No duck> Duck. Should I start reverting to reverse psychology? What was wrong with the duck? I liked it. Roy put up a link to our book's Facebook page---you remember, that book we've been writing for about a zillion decades that never actually materializes. I promise (I hope) that it isn't just a pipe dream. So the book's Facebook page has a whopping 8 fans and their photos are shown on our sidebar. Does Jesse the Chinchilla Lover want his photo on Shrink Rap? Do we want to advertise our 8 fans? I take it down. And Roy tells me he's frustrated that I undo things he does without talking to him first. But my duck-- he took down my duck! And he didn't talk to me first.

Why does Roy want the Facebook page up anyway? Does it matter? How will our Shrink Rap Book FB page change the world? Oh, we had tried a Shrink Rap friend page, but that was too hard to manage. I had to sign out of my own account and confirm new friends, and interact with them, and I'm a bit on overload (in case you couldn't tell!). We tried a "fan" page and that was fine. Only it was linked and combined with the friend page and who knew what was what. I was pretty confused and I created them! So Roy made us a FB book page, only the book's not out, so he doesn't want anyone to know. But he does want 25 people to be fans so he can reserve a specific URL for it. HuH? And then he put his twitter feed in to it which would be good---Shrink Rap posts would populate the wall, but then he had a twitter conference and all sorts of random tweets went twitting away on the wall and in my News Feed. I think I'm way too old for this. Anyway, Roy is driving me crazy.

Please join our Shrink Rap Book page so Roy can drive you crazy, too.

And Clink has a new "old" post up on Shrink Rap Today over at Psychology Today.

You Need Help!

Sometimes in my real life it becomes obvious that a friend or acquaintance is having a problem. Either they are wearing obvious signs of mental illness or they just show signs of being 'stuck' in life or, worse, of moving backwards. Often they don't see it. I suppose there is the outsider's vantage point of making a judgment that may reflect my own value system and not their reality: to me, I may see someone who has family and job and connections who sees leaving those things as a healthy escape and their withdrawal as a good kind of comfort with keeping their own company. Usually these aren't my close friends, but what do you do when you notice that someone in your life is changing and might possibly benefit from help?

In general, I've found that "You need help" is not helpful. People hear this as an insult, not as a kind suggestion from a concerned friend. And from a psychiatrist friend it may be worse and easier to blow off---shrinks think everyone's crazy, they push drugs, they think everyone needs therapy, they see the world in a skewed way (at least this is how the commercial runs).

So I wondered: how do people let their friends know they need help in a way that inspires them to get it in the absence of a crisis? If you're in treatment because someone else suggested it, what enabled you to hear the suggestion without being wounded or insulted?

Three Shrink Rappers Meditating on a Mountain Top....

On my post on meditation, Guzman from Montevideo, Uruguay left us a joke. I mentioned in that post that my mother took me to learn Transcendental Meditation when I was 10. Odd coincidence, but my mother also worked at the US embassy in Montevideo, long ago. Did you know her Guzman? It was many decades ago.

So I took Guzman's joke and I modified it to suit us three Shrink Rappers because it kind of suited our personalities:
Guzmán. said...

Jiddu Krishnamurti telling a joke...

“There are three shrink rapping monks, who had been sitting in deep meditation for many years amidst the Himalayan snow peaks, never speaking a word, in utter silence. One morning, Roy one of the three suddenly speaks up and says, ‘What a lovely morning this is.’ And he falls silent again. Five years of silence pass, when all at once a bird flies over and pulls the duct tape off monk Dinah's mouth and she speaks up and says, ‘But we could do with some rain.’ There is silence among them for another five years, when suddenly ClinkShrink, the third monk says, ‘Why can’t you two stop chattering?”


http://www.katinkahesselink.net/kr/jokes.html
http://seaunaluzparaustedmismo.blogspot.com/

Genetic Friendships

Here's an interesting article I came across about the role of genetics in friendships. Two researchers studied genetics found in social networks. They asked people in two longitudinal studies to name their friends, then they compared certain genetic markers. They found that the DRD2 gene, which is associated with alcoholism, tends to cluster among friends. In other words, DRD2 positive people tend to be friends with other DRD2 people. Conversely, the CYP2A6 gene carriers tended to make friends with CYP2A6 negative people. This gene is associated with people who have open personality styles. In other words, a tendency to seek out variety and new ideas.

I'm not sure what to make of all this except to say I think it's interesting that there may be a biologically driven reason why Dinah and I are friends. In many ways we're the exact opposite. Dinah is a whirling dervish of multi-tasking in a way that I find exhausting, yet she seems to thrive on it. I'm an obsessionally detail-oriented and data-driven person who never loses her car keys (or drowns a cell phone). I enjoy living this way but have no doubt that Dinah would go mad from boredom within hours if we ever woke up and found our lives had been switched. I can guess which one of us has the CYP2A6 gene. The scientists would say that we are friends because we have complimentary genetics---traits that balance off and help one another. And I guess that's true. Our book might not ever have been finished if Dinah hadn't kept us moving and on task. And it wouldn't have been as organized and readable if I hadn't followed up with the editing. So it all works out in the end.

Now we just need to find a gene that protects against cell phone loss.

The Sunday Morning Shrink Rapper Update.

I've decided to start reading the Sunday New York Times in bed--- no electronic distractions and I actually sort of read. I love the internet, but I think it makes me crazy.

The NY Times has a feature on Debra Winger and talks about her acting come back in the role of Frances on In Treatment. Click here if you'd like to read it.

I'm reading a wonderful book, a memoir by Dr. Mark Vonnegut called Just Like Someone With Mental Illness Only More So. When I was a kid, I loved Kurt Vonnegut's novels. Unusual family with lots of genius and mental illness. I will write more about the book when I finish it, maybe later today?

Tried a great new pizza place last night. Trouble parking and I thought I'd never go there again, and then we ordered a boring pizza because we have topping-issues in my marriage. Great spinach salad, and as we waited for the pie, I coveted the pizza's around us with sausage, veggies, mushrooms, oh.... but then our Four Cheese Pizza arrived and it was amazing. We didn't even mind that we were by far the oldest people in the place, and I will definitely go again, maybe on a weekday. So here's a plug for Iggy's.

As for the rest of my day? Roy wanted me to go to lunch with him so he could convert me into someone who fully understands the details of an issue that has come up in our state with hospital reimbursements. The restaurant he chose isn't open on Sundays. Oh, and he's decided he's busy with one of his many other projects. Clink wanted to work on posting another podcast with me, but got a last minute invite to a birthday party and has blown me off. I've pointed out to her that she was on my "A" list as a first-choice friend for a Sunday afternoon. The day-before birthday party invite and she was clearly on that person's "B" list. Apparently, my company doesn't compare to the prospect of birthday cake.

Our little dog, Kobe, the hyperactive one, was shaved down yesterday in an event called grooming. I suggested husband take him to the Ravens Game (Kobe would like that) but was told, "As a comfort dog? Kobe is the farthest thing from a comfort dog."

My Friend, My Shrink

I just finished reading Dr. Gary Small's book, The Naked Lady Who Stood on Her Head. I talked about it during our podcast, and maybe, someday, that podcast will be posted.*

In the final chapter of the book, Dr. Small talks about his mentor, friend, and father-figure who has been mentioned throughout the book. The mentor approaches him on the golf course, where they meet to talk, and says he needs psychotherapy and Gary is the man to do it. The author is surprised, hesitant, and a bit uncomfortable with the demand (it comes as more than a request). His wife likens it to the need for a plumber or a dentist, and Dr. Small takes on the task. The mentor calls all the shots: where the meetings will be, what pastry they will eat, the form of his payment. The author initially misses the diagnosis and uses this as an example of how one can be blinded.

So is it okay for a friend to treat a friend?

I was in an institution where the resounding feeling is that psychiatric disorders are medical diseases like any other: the patient should go where the care is best. Obviously, our institution gave the best care, and so there was no taboo about faculty being treated (or even hospitalized) within the department. This is not to say that everyone treated their friends, but people might not move their care as far away as one might imagine (and sometimes people treated their friends).

At the same time, the standard professional boundaries suggest that friends should not treat friends, and that such arrangements are not kosher, especially after the fact if the treatment is called in to question.

Dr. Small talks about a delay in diagnosis. He doesn't talk about the fact that the patient here is dictating the care in a way we generally don't view as being helpfu to patients-- even VIP patients-- or that the desire to please authority figures can be very powerful.
------
* Regarding the My Three Shrinks podcast: We've decided that I, the non-geek, should try to produce the podcasts for the near future. Roy said he'd rather stick a fork in his eye than teach me to do this. Clink is trying, but even the process of transferring the recordings to my computer has been rough, not to mention that our podcast programs don't sync. Soon... we hope.

So, Like What's a Friend?

I just went to add someone to my Facebook list. It's someone I've spoken to once on a professional topic, but hey, it was a nice conversation, and information about this person came through my Facebook newsfeed, and if I can have all these friends from my past lives, why not?

This time, however, I got an interesting message from Facebook. The button didn't just say "Send Friend Request"....it asked "Are you Sure You Know Zelda?" (Not her real name). And then, there was a whole disclaimer, which I found to be a bit threatening:


If you send a request to a stranger, it will be considered spam and your friend request will be blocked temporarily. Please only send this request if you know Zelda.

I was about to press the button but I thought, Do I know Zelda? How well do I have to know someone to qualify? I've never actually met Zelda--oh, actually I did pass her on the street in New Orleans during APA, but I was in a rush so I didn't stop and introduce myself and say "Zelda, it's me, Dinah, can I know you now?" I decided that one phone conversation was enough, and that I know Zelda. Maybe she'll agree, but if she doesn't that's fine. I just hate being threatened with a "spam" designation. I'm many things, but Spam I'm not.

Be Our Friend!

I'm trying to figure out the details of an organizational Facebook Page. Somehow, I made two from the same account, and so you can be our Friend on Facebook, or you can be our Fan on Facebook. There's a duck. There's some sideline stuff. There's our feet. I'm hoping I can get Roy to feed his tweets to the Facebook page so that our posts will show up there. I haven't got the kinks out, but please do Friend us and Fan us, especially in this heat! If you look for us on Facebook, we're Shrink Rap, the ones with the feets.

Thanks for being our friend!
And here's the link: Shrink Rap on Facebook

Let Me Tell You About My Friend

Hypothetical situation (with a little ring of possibility)....

So a new patient shows up at my door, referred by a friend. The patient used to be in treatment with my friend, but the friend is moving to another state. The patient is sad, she will miss her old doctor who helped her so much, and while we hit it off just fine, it's clear that I can't fill my friend's shoes.

Now here is the thing I'm wondering about: the friend who used to treat the patient is my good friend, someone I talk to all the time --Are we thinking along the lines of a Camel? Perhaps, but I'll never tell. After the move, I'll still talk to her all the time, and I'll still see her socially, even if it means a bit of planning or trekking. Should I tell the patient? My initial thought is "yes" that this will be a connection, that I can relay regards and that the patient (and the doc) won't feel so cut off. But then I wonder if maybe it will be hard to know that I am seeing the old shrink when she can't, if somehow this might be frustrating?

I'd ask here, but clearly this is one where the answers may be very individual,--oh, but why not? Go for it!

Unfriended!

I like Facebook, kinda sortof. It fits in well with my life as a voyeur, and I get to participate. My friends are my friends (those on FB), I have some random people there--like a carpool mom I don't really know, and I have a lot of elementary/high school folks, some of whom I've found, and some of who have found me.

So some of these people who want to be my friends are high school folks I don't remember. Okay, maybe the name is familiar, or maybe it's not. They have all the same High School friends in common and they live where I grew up, and hey, who wants to hurt anyone's feelings, so I've confirmed pretty much anyone who asks. Why not? I'll tell you why not, because some of these people play all these games on Facebook (Farmville and Bejeweled are particularly popular among my peers) and who cares if they got a new animal? But every time I sign on to FB, my news feed is filled with their scores. Fat Doctor---Oh, she's the best, but I took her feed off my FB page, though we still remain friends.

I decided to Unfriend the people I don't know, don't remember, and who fill up my news feed. FB doesn't tell you if you're "un" friended, right? Only I unfriended some stranger and two days later I got friend request from her, again! No No No No! Go away! Go play Farmville!

You know, I am too old for this stuff.

I Have A Friend....

ClinkShrink is looking for something to climb. Roy is collecting links to Mental Health Blogs: Thanks for all your contributions and if you'd like to add another mental health blog to the list, please visit Roy's post and comment.

I titled this post "I have a friend..." because it's not an unusual way for someone to start a conversation with a psychiatrist about a mental health problem in a social setting-- maybe it's about a friend, maybe it's about themselves, I never ask, I take it at face value. Sometimes I later hear, "actually it's my problem."

So I have a friend (--really) ....

We're together in a public place, there are people around that we know, probably not within earshot, but who knows? The friend is, well, more of an acquaintance-- we don't know each other so well.

"I know you don't like Xanax, but it's the only thing that helps when my thoughts race."

I'm caught off guard. It was a statement, not a question, and I should have listened.
I mumble something. Whatever it was, it was probably the wrong thing to say.

"Why don't you like Xanax?" Friend asks.

Oy: if you haven't read Roy's post on Why Docs Don't Like Xanax (some of us), then by all means, CLICK HERE.

Issues with addiction, I say.

"I don't take it every day, just when I can't sleep and my thoughts are racing. What else could I take?"

Okay, at this point I retrospectively cringe at my response. What was I thinking? Roy and ClinkShrink would crawl under a rock and pretend they don't know me. I mumble something about Ativan and Valium being less addictive. I mumbled something about perhaps the Xanax wasn't a problem. Oh, I recommend these medications rarely, really rarely, and only to patients I've carefully evaluated. What was I thinking to suggest the names of other meds? Or what wasn't I thinking?

The subject changed, we didn't discuss it any farther, but I was left obsessing about the weirdness of my response, the irresponsibility of it, the cavalierness of even hinting that certain medications (addictive ones at that) might be better than something already prescribed for a condition I didn't explore, by another physician, for a person I didn't know terribly well.

So this post will now have two themes:
1) When personal friends asks a psychiatrist (this psychiatrist in particular) for advice.
2) What I did wrong, which is basically everything.

Friends ask me for suggestions from time to time. ClinkShrink and Roy might (I'm not sure, I'm surmising this) say one shouldn't give any suggestions and that by listening, engaging, offering advice, that one essentially establishes a doctor-patient relationship and becomes responsible for them and becomes open to all the obligations inherent in any doctor-patient relationship, including the right to be sued for malpractice. Again, I'm putting words in their mouths, so Clink and Roy: do feel free to add to the bottom of this post.

I don't tend to worry about being sued. And when a friend wants to talk about a problem, knowing I am a psychiatrist, I listen and I don't usually immediately say, "Ask your Doctor" --because, well, it feels dismissive and I feel like the voice-over in one of the pharmaceutical commercials. I usually listen, answer what's asked to the extent that I can, and if the situation warrants, I gently suggest it might be worthwhile to have at least a one-time psychiatric evaluation. I never, ever, tell my friends they need long-term intensive psychotherapy or specific meds: that would be the job of the evaluating psychiatrist and I like having friends! I will refer friends to shrinks I think they'd like, if they want, though, hey, it's my best guess as to interpersonal/professional chemistry. I try to figure out an appropriate boundary -- somewhere that's caring but not opening myself up to to hearing all sorts of overly personal details-- and I try not to upset my friends or leave them feeling uncomfortable. Finally, I try to be of help.


Here's what I did wrong with my Xanax-for-racing-thoughts friend:

• I didn't listen to the issue. Was there even a question or was it just a request that I hear that Xanax is helpful to this particular person? I never found that out.

• If there was a question as to the appropriateness of this particular medication for this particular person, I really was in no position to comment or second-guess the doc who prescribed the med.

• I jumped to a conclusion that, in the moment, I didn't even realize I was jumping to: The friend mentioned that Xanax helped with racing thoughts. I know this friend has trouble sleeping when there is a lot going on. "Racing thoughts" are a symptom of Bipolar Disorder-- it's a term used to describe the symptom of having one's thoughts go so fast that the patient can't keep up with them. They don't generally happen with conditions other than mania, and I assumed the friend wasn't really having "racing thoughts" but anxious ruminations associated with insomnia-- in other words, dwelling on daytime events and worrying which were interfering with sleep. I don't know any details, it was a quick assumption. It wouldn't have been appropriate ( nor would I have wanted) to ask all that I'd need to ask to figure out the precise phenomena, diagnosis, or if Xanax or something else was the appropriate treatment. I also assumed this friend doesn't have a substance abuse history and I'd have no way of knowing that....perhaps any addictive drug, be it Xanax, Valium, Ativan...might be the wrong choice. I should have kept quiet.
  

The subject changed, it took me a little bit to process what I'd said and what I hadn't said, and somewhere in there, we followed it up with a second, briefer conversation in which I said much of what I've said here.

Hoping my friend is now sleeping better....

He Got It!!!

Four hours in line, with details along the way.  The power went out, the biology of it all got a bit uncomfortable (or so I'm told).  The fear that they might run out....it was intense.  Oh, Roy will say I'm exaggerating, overly dramatic, catastrophic even.  After all, it's just a cell phone.  And apparently there were, indeed, lines.

Now where is Roy with his new iPhone?

I asked if takes pictures?  So far no answer.

I called, got the same old message.  Is Roy one person or does he now have two cellphones?  Does he have a new number?  Will I ever hear from him again, or is my Samsung slide (with no internet capability) no longer in his league?  Mine does have a camera.  I think I'll send Roy a picture of my feet.   I got my toes to smile.

I want to see it!  Is it bigger, better, more more more than last year's model?  Someone I work with has the old iPhone, can I introduce them, do side-by-side shopping?

----

Finally, while I'm rambling silliness on such a serious topic as the new iPhone, I want to take this opportunity to thank ClinkShrink for staying with Max and teenager the last few days so I could have a mini-vacation.  I'm recharged and so happy that everyone here is alive and well.  I am sorry that teenager ate the Reeses Puff cereal that Clink likes.

You Puzzle Me

Now that we have a couple years of blogging under our belts, I thought I'd do a little pop quiz for you folks who have stuck with us from the beginning. Click on the link below to go to the Shrink Rap Crossword to test your knowledge of Shrink Rap trivia. You can print out the web page and do the crossword at your leisure.

For people who want to brush up with a quick review first, I recommend these links:

Psych Notes For Smilies
My Planned Nervous Breakdown
True Confessions
Shrinks On Segs

Now get to it!

Click on the red link below for

Shrink Rap Puzzle

Note from Dinah: I love it!! Interactive silliness. You ate too many birthday mushrooms!! Also, please take our sidebar poll.

for me, back to coffee and the New York Times.

Dropping By

My office is in a building with lots of other offices and some stores. It's not uncommon that friends will mention they've been in the building for a reason, or they might say they're going to be there and might drop by. I generally suggest that they not do that-- I see patients back-to-back most days, it's more than a bit awkward to have my personal life intrude on my professional life, though I don't want my friends to think I don't love seeing them, just not during the work day.

Yesterday, between sessions, I got this text message from a friend, "I'm in the building. U there?"

I called and said, "I have to see a patient quickly, come up in a little bit."

It felt like a funny, meant-to-be sort of thing set up by the cosmos. I didn't tell the friend all the details, but I did have a patient scheduled that hour only the night before she'd called and said she forgot what time the appointment was. I told her (same time as friend showing up), but as an afterthought I added that I had another time available later if that was more convenient. It was, she took it, thereby freeing the cosmic time slot. And you know I don't do "med checks" but the patient I'd scheduled into that time is the only patient in my entire practice that I see for brief med checks-- a patient who came to me completely stable with no symptoms or side effects, no desire for psychotherapy, who could easily be managed by an internist (and has been told that) but he wants a psychiatrist to write his prescription.

Friend came up and we chatted. He sat where the patients sat, I sat where I sit. I'm not the quietest of therapists, but when I'm doing psychotherapy, it's all about the patient. I got to talk about me. He looked around, asked about the position of the clocks. Why doesn't the patient get to see a clock? Why don't I have a desk? We talked about some other stuff. I didn't ask if he needed more meds. He left when the hour was up. I wondered if he felt funny that the patient in the waiting room must have thought he was a patient.

It was nice to see you, Roy.

The Shrink Next Door

This is our 600th Post!
Lately my neighbors have been apologizing to me, which feels a little bit weird. We'll have brief (OK, sometimes not so brief) conversations and they end them by saying something to the effect of, "I'm sorry to chew your ear off," or "I know you're off duty, so I'm sorry about that," or words to that effect. They know I'm a psychiatrist so I guess they think they're burdening me when they do the normal problem-sharing thing that goes along with being a friendly neighbor. Now, it's possible that I get more than the usual share of mental-health related problem sharing because they know what I do for a living. And it's true I know lots of stuff about who in the neighborhood is on which medication, or who would never in their life take that particular medication, or who is looking for a psych referral (I give them names but they rarely follow through), just because of what I do for a living. But it doesn't feel like they're burdening me. I like my neighbors. I've never had a bad one, and that's pretty unusual considering how long I've lived here.

That being said, I can't say that I've ever gone to my mechanic neighbor for car advice or to my hair stylist neighbor for coloring advice (although Dinah probably thinks I should) but that's not because I don't think they'd help me if I asked for it. It just never occurs to me to ask. It is nice to know though that any one of those folks who apologized to me for "problem dumping" would be just as quick to listen to me if the tables were turned. That's just being a good neighbor.

Roy Issues A Challenge

The history of the vote: Roy wanted to know who reads Shrink Rap and he put up a poll. This was a while ago. In a month, there were 198 votes. I wondered who all the "other" votes were and, 8 days ago, resurrected the poll with multi-vote and write-in options, . Roy, who likes statistics and keeping track of things, wonders why there are already 104 votes. He wants us to place bets on how many Shrink Rap readers will vote in a month. The guesses:

Roy: 246
Clink: 186
Dinah: 275

We haven't discussed what the prize will be, though presumably the winner needs to be the closet vote that hasn't gone over. Or maybe just the closest? We're not much for rules here at Shrink Rap. No obscenities, that's about it. Lots of Ducks. Maybe the losers could prepare duck for me with my favorite sauce? Note my optimism!

Okay, so Vote on our sidebar, let us know who you are. Help me win Roy's challenge!

And for the curious, the OTHERS so far:

just got here thru a link in a news article about iphone crazy
chaplain
democratic network engineer
frustrated late-teenager
clinical social
work student
college student
CASAC Student
Medical Student (starting
in August)
blogger
student
science writer
blogger/psychology
grad student
medical librarian
I am in nursing school, and I am also in
psychotherapy
nursing student
medical student
medical student
don't know her
lesbian housewife
I am co-blogger and am patient with
Dinah.
Umm, I'm one of the 3 bloggers.
Other Mental Health Provider
Student

FYI, ClinkShrink is apparently patient with me. This from someone who videotaped my dog yawning this weekend. And I can't resist:

On Being Connected

This is a post that's about me and my life and something that's important to me, and it's about psychiatry, even if it might not seem that way.

I am very lucky. I have some really wonderful people in my life--both family and friends. My husband and I met our freshman year of college-- we've been together our entire adult lives, we carry each others' histories, we've shared nearly every event (including and especially the Red Sox victory in the World Series in 2004, even if he was in a hotel room in Florida), he knows all the inside jokes, let me write chemistry equations all over his legs, listened to my pre-med then med school angst, has survived endless shrinky dinner parties (--newsflash: he's not a doc).

And then there's the Judge, along with her dog Tex (who vomited on my carpet this morning, thank you for that Tex), who makes her way over for coffee every morning, still in juice-can sized hair curlers and looking very lovely nonetheless. Every morning you say? Every morning. Occasionally, wine later in the day, once she called from her car to ask if I'd go out for soup with her (I did) and the Judge is always up for a movie, so my standing date to chick flicks. I like Carol (and doggy Prize) and Maria (and Nelly who jumped on my bed, tracked mud through the bathroom, & ate the garbage) too, but they're more sporadic and I often hear about their lives in snippets, not as a continuous episode.

Camel (see my post: Everyone needs a Camel) lives pretty far away, but we talk often, sometimes daily, always on the go, sometimes for pretty long. We talk about psychiatry, the hubbies, the kids, whatever. My first stop when I have a problem that needs solving. Camel has good ideas and another minor bonus about her: very good taste in food-- when we're in restaurants together, sometimes I just order whatever she's having because hers is always good.

ClinkShrink has ragged on me for 20 years now, she's in my life more since the blog (this is good). Mostly though, I remember that residency wasn't always the easiest time for me-- I was new to Baltimore, soon pregnant, missing my friends and feeling a bit isolated, as well as exhausted. There were times there I called Clink every night, for long periods of time. She talked about her cats (Spike, then Elavil and Prozac, I kid you not). It was nice. It's probably taken me 20 years to appreciate just how nice.

Linda from med school writes in frequent spurts, glimpses of her life as mother and shrink (in that order). She listens to some of the garbage that courses through my mind, stuff I'm happy to have someone a little bit at a distance to tell these things to.

And then there's ABF. Where do I begin? She sat in front of me in Mr. Wasserman's civics class in Junior High. We lost each other in college-- she sort of fell off the map right after she visited me during a break our sophomore year. I next heard from her 10 years later, and again, 10 years after that. And then came e-mail, and when ABF got email-- maybe 2 years ago?, we started sharing our lives. Again. We took off from somewhere new, it's not just where we left off, and we email, everyday, probably 3 times a day. We've caught up on the past, I think, shared our views on religion, child-raising, weight loss efforts, what we're having for dinner (yes, this is what psychiatrists talk about with their friends, it's a step beyond the endless junior high school discussions about pierced ears and shampoo). ABF has two children, a son with autism, she spent today helping her daughter with her Spanish class project, she knows what I did today and every day. She's getting over a cold, tea and chicken soup have helped, and the weather in Boston has been quite cold lately. I go through my days filtering my experiences with the thoughts that "Oh, I'll tell ABF that later." I've only seen ABF once in recent years, it's funny that this relationship of bits-and-pieces of the mostly mundane, is so important to me.

I forgot some others-- some of my email relationships have been very meaningful to me, but have petered out at least in their day-to-day investment. Cuz B used to write several times a week, I knew when she took a walk, when she had her hopes up about an audition, when a boy was on her mind. Now it's down to once a week, we skim over some of the little stuff, she's still huge in my heart. Victor has made his way in, and now has been dragged to hear a psychoanalyst speak on the most depressing of Russian films. Roy, of course, is special, a friend I connect with on perhaps a different level; I think he wants me to appreciate Monty Python and it may be a climb. Eight years of lunch with Lisa on Monday-- friendship contained in its own little box-- and I still miss her.

When my mother was alive, she cared about my life in the most detailed way. She lived a few hours away, I didn't see her often, but who else cared so much about the little things. If I bought a new shirt, who else would ever ask me to describe it in detail? After she died, I wished I'd had a digital camera so I could have photographed and e-mailed her the smallest of things, she liked to picture everything in her head.

The blog is like it's own little world-away-from-reality of connection. The same people visit and reliably post. I wonder how Foofoo5 is doing. Carrie, Midwife With a Knife, and Lily come daily, Sarebear wanders in and out, JCAT, Rach, and the assorted others who touch our bloglives at particular moments when something resonates.

So I said this would have something to do with psychiatry, not just my personal ramblings. Today my youngest turns 13, I think I'm feeling a little sentimental. My husband and I were talking about plans for the day, I referred to her "the baby" as I often do, and he said, "She's not a baby anymore." Oh, she still is.

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Obviously, psychotherapy is a way of being connected. Someone listens, they listen hard, they care about the details of your life, they remember them week to week or month to month, they want to know what happens in the next chapter, in a sense they collect you. Maybe it's love, in some funny sense of the word, certainly it's intimacy, sometimes it's simply a business affair. Hopefully some of it's about mutual caring.

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There, did I tie it together?

Holiday Cards

So Fat Doctor posted about writing her holiday cards. I feel like she's my friend....it's the strangest thing, but I track this person's life. I know when her sister had bladder surgery, when she painted her toenails blue, and how did she lose 8 pounds in one week??? I wonder what state she lives in (not to mention how she works on the same medical unit as her mother). Son, husband, sister, big dog, little dog, it's like Reality Blogger.

Holiday Cards: growing up, my family never sent them. I grew up (I think) and started sending them, including pics after we had kids. I learned to paste in photos, and while I'm not much for newsy letters, I've moved from "our year in review in pictures" to a few travel photos and a sentence about each family member. Some years it's simply "the kids have too many activities to list." Mostly, I keep it short and sweet, and I don't mention the more troublesome aspects of life: there are always a few. If you know me, you hear them, if our relationship is sustained only by the yearly holiday card, I leave out the bad stuff. On the receiving end, we've gotten some really interesting ones. Last year was the first time we learned someone's ejection fraction from their holiday newsletter. One friend sent a month-by-month, 2 page, single-spaced account of every kiddy performance and academic conference.

Fat Doctor and I exchanged e-cards off blog (-- I think this is called "back door"). She has a name (only a first name)! I was shocked, I've wondered what state she lives in, how fat she really is, and my husband has wondered if she really exists, but it never occurred to me that she'd have any name but "Fat Doctor" or FD. It was like a bubble bursting, and while it's a nice name, it was a little bit disappointing, like seeing your favorite glamorous movie star without their makeup. The newsletter itself was full-form Fat Doctor, I loved it. Gorgeous, gorgeous little boy -- he's made brief appearances on the blog, so an old familiar face-- and much of the news I knew. Up there with writing about one's ejection fraction, Fat Doctor sends advance directives for both herself and Husband. He wants his life sustained as long as he can operate the TV remote. This reminds me of Roy, who once said he wanted to be kept alive as long as he could move a cursor by any means. I wonder if Roy puts that in his holiday notes? For the record, and this did not make my holiday card: If I am unable to consent, I am never to be put on a salt-free, diabetic diet. I mean that.

Are you asking, what's this got to do with Psychiatry?? We didn't get very many comments on our anti-depressants and suicide posts, timely stuff that it is; I figured I'd digress to pleasanter topics for a few moments. Maybe Roy will fill us in on the FDA hearings.

'Tis the season...