Lockup Doc

The relationship between a psychiatrist and patient must be different from that between two friends. Friends share problems and concerns with each other because of the mutual give-and-take foundation on which friendships are based.

A psychiatrist-patient relationship is very different. A patient comes to and pays a psychiatrist for professional services. While a psychiatrist is probably going to be more effective by showing some human qualities and not being a completely blank slate, there is still a necessary professional veil that the psychiatrist must wear.

What I was always taught and still believe to be solid advice is that a psychiatrist should not disclose any significant personal information to a patient unless the intent is for that disclosure to help the patient. That’s been a great barometer that I’ve used with myself over the years. If I find myself beginning to talk about my own life, I stop myself and double-check my intentions. Read more…

It’s an unfortunate scenario I’ve seen time and time again:

• Parent goes to prison.
• Child, who already felt neglected by parent, becomes more upset when parent ends up behind bars. Child either blames the parent for misbehavior that results in parent being taken away from child and/or blames him or herself (as children often do).
• Parent tries to have contact with child via phone calls, letters, or visits.
• Child decides that he or she wants nothing to do with parent
• Parent, often with poor parenting and poor coping skills, feels like a failure and simultaneously is upset about being rejected.
• Parent needs to decide how to handle situation and often chooses to Read more…

I used to have a more “normal” job.

Early in my career I worked in a large medical center and hospital and rotated through a call schedule. I got called into the ER regularly. I covered the inpatient unit and performed consultations on the medical and surgical units. I did all of the typical work tasks associated with a traditional practice.

Then I left it all.

I started working half-time in correctional psychiatry. I have worked in various other less traditional settings to fill the other half of my schedule over the years, but most of it has been spent working with people with developmental disabilities.

My work life is Read more…

As a psychiatrist who has now been practicing for over a decade, I think back to the days of residency and fellowship and realize how much my approach to prescribing benzodiazepines has changed.

One of the key faculty members in my psychiatry residency program was considered an expert in treating anxiety disorders. He was very liberal with his prescription of benzodiazepines, the anti-anxiety class of medications including diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan), alprazolam (Xanax) and others.

Having no other frame of reference, I naively adopted his unsparing prescription-writing habit of these not-so-benign medications. I unquestioningly steered down this path for the first couple years of my post-training practice.

Then I had the good fortune of working with a very competent group of experienced psychiatrists who were in full-time clinical practice. Regularly collaborating on cases with them helped to initiate my transformation to more conservative, and in my opinion, more appropriate,  prescribing habits.

My prescription style inevitably evolved further when Read more…

It may surprise some people to hear that not all inmates, not even the ones who see psychiatrists, have difficulty coping with incarceration. Certainly some do, but many others are more stressed about family/relationship issues, financial problems, or the prospect of being unemployed felons upon release. Some inmates have found positive approaches to incarceration that make it less stressful and more productive while others struggle and often find themselves in undesirable situations.

Since I regularly see prisoners with a wide variety of effective and ineffective approaches to their incarcerations, I decided to compile a list of suggestions for how one could make prison or jail time more palatable. This list is not all-inclusive and is in no particular order. I offer no guarantees and hope that you will never seriously need a list such as this!

1. Stay busy and healthy: Some inmates do virtually nothing in prison, and I believe this is a mistake. Although freedoms are limited, there are still many things inmates can do to make the time pass more quickly, stay physically and mentally healthy, and better themselves. Go to the prison library regularly and read lots of books. Earn your HSED/GED or take college classes if they are available. Do not pass up the opportunity to go to recreation. As your health permits, work out regularly. You’ll feel better, be less likely to be a target, sleep better, and you’ll likely be healthier.

2. Don’t draw attention to yourself: “Lay low” is good advice. Try not to come up on the radar Read more…

Malingering, which means to feign or exaggerate symptoms for secondary gain, occurs in all medical settings but is especially prevalent in jails and prisons. While it essential for all health care professionals working in corrections to become proficient in detecting malingering, even those working in non-correctional environments will be better clinicians if they learn this skill.

In the December 2009 issue of Current Psychiatry, Lawrence Reccoppa, MD, a correctional psychiatrist from Florida, wrote a brief article entitled, “Mentally ill or malingering? 3 clues cast doubt.”

The “3 D’s,” as he calls them: Read more…

(The following is a fictional vignette based on thousands of real patient encounters. Any resemblance to an actual person is purely coincidental.)

The heavy door slammed with an echo he’d never forget. He thought he could trust her, but he had been proven wrong. He should’ve known not to trust anybody in prison. In fact, throughout most of his life he’d known only a few people he ever could trust. Naked, cold, humiliated and feeling as though he had been violated again, “David” now wanted to die more than ever. He didn’t care how; it didn’t matter if it hurt. He just needed to end it all. But, he would soon realize that it would be nearly impossible to do. Nearly ever imaginable method of suicide had been removed from him. He was now “safe” in the eyes of the prison, but he sunk into a deeper depression.

It was David’s first time in prison. He had spent a few days in jail prior to his current age of 22, but it was remarkable that he hadn’t gotten himself into more trouble. His father was a career criminal who had repeatedly emotionally, physically, and sexually abused him as he was growing up. David had grown up far too fast. He had had few boundaries and rules and almost no adult supervision in his younger years. He started smoking cigarettes at age 10, started drinking at 12, and was using marijuana regularly by 13.

Despite having the deck stacked against him, David was Read more…