IS PSYCHIATRY DYING? A REPRISE, by Art Smukler, author & psychiatrist

Since publishing this post last October, and living through the tragedy of Robin Williams suicide, my thoughts seem even more immediate and important. We can’t just watch our wonderful profession sink into mediocrity. Too many people need our expertise…

Once upon a time, psychiatrists spent uncountable hours during their training learning how to do psychotherapy. They studied the vagaries of the unconscious, had intensive training presenting cases to highly trained supervisors, read volumes on how the psychiatric greats treated their patients, and helped train psychologists, social workers, MFTs and other therapists to do therapy.

Then Insurance companies sold the concept of managed care. The mantra was simple. Treat symptoms not people. Don’t take time to understand someone, just take the depression and anxiety away. Time is money. A good psychiatrist is one who doesn’t use time, but fixes things quickly. Medication is the cure. Psychotherapy? Leave it to the other therapists.

Well, the insurance companies did what they set out to do. All the money they were paying psychiatrists (and I can assure you that those fees were nowhere near what surgeons or other specialists made) now went to the middle managers who were paid to limit care. Big business defined what was good psychiatry and what was bad psychiatry.

So what does it all mean? Should psychiatrists be happy prescribing medication and just let other therapists do psychotherapy?

To me, psychiatry is a specialty that is a combination of medicine, psychology and poetry. Only psychiatrists go to medical school and have the opportunity to understand the complete person. The mind and the body always work together. One can’t exist without the other. To just prescribe meds is the equivalent of removing only the top of the iceberg. What about the main part of the person, the part that was formed back in childhood, the part that psychotherapy reaches.

In Brave New World, the dubious answer to human pain was the drug “soma”. We can’t let that happen in our society. Just using drugs because they are a cheaper way to calm the masses and save money is short-sighted and hurtful.

Psychiatrists used to be masters of the mind. They used their unique skills to help all psychological professionals understand what people were all about and how to help them combat the psychological torture that was ruining their lives.

Limiting a psychiatrist’s skills to prescribing medication starts at the top. If training programs let this happen, they are short-changing all of us. If psychiatrists just want to make more money and not learn how to be masters of psychotherapy they are no longer masters of their profession. Master carpenters, master electricians, master cardiologists and masters of anything are an important part of creating a society based on excellence. Excellence is what we should strive for.

Is psychiatry dying?

Not in my office…

Art Smukler is an award-winning psychiatrist and author of Chasing Backwards, a psychological murder mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear. All are available as paperbacks and eBooks.

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HARNESSING OBSESSIONS TO WRITE BOOKS & STORIES, by Art Smukler, author & psychiatrist

Experiences that play over and over in our minds are often the ones that authors can turn into books or stories. Like the lyrics or tunes from a catchy song that you just can’t stop humming, an event or encounter can also keep replaying.

Rather than tuning out the obsessive thought, consider doing everything possible to flesh it out and examine all aspects of the experience. Often, our mind latches on to something for a reason. If we force ourselves to look deeper, there can be a surprising array of explanations that clarify why the experience just won’t go away and leave us alone.

A number of years ago, a patient suffering from intense bouts of depression described how he was placed at bed-rest at the age of six in a pediatric hospital for one year. He was suffering from Legg Perthes Disease, a congenital hip dysplasia, which if not treated appropriately would have led to severe crippling.

I couldn’t get the image of this little boy, trapped in a bed and hooked up to weights and pulleys, out of my head. At first I tried ignoring the image, but it just kept reappearing. Eventually, I sat down and forced myself to examine why this image was haunting me.

The explanation was a lot closer to my conscious mind than I realized. My patient was hospitalized at the Children’s Seaside House in Atlantic City, New Jersey. I had spent my childhood summers not far from where the hospital was located and actually remembered seeing children playing on the hospital grounds. As a child, the sight of those crippled children horrified me. Obviously, even as an adult physician, the memory was still disturbing.

So, one thought led to another and my character, Joe Belmont, a tough Italian medical student, with a traumatic past, was born.

From multiple hiding places within the Philadelphia neighborhood where he grew up, to the Jersey shore hospital where he was placed at bed-rest for 12 nightmarish months, to the financial district of Zürich, Switzerland, Joe desperately tries to unlock the secrets that have marked him for death. Finally he realizes that his only hope of survival lies in the one place he has always avoided, the darkest corner of his own mind.

With a lot of research and work, my obsession with a helpless little boy trapped in a hospital bed, was turned into a novel.

Obsessions are intense feelings about a particular person, place, feeling, or way of life. Many authors follow their obsessions from one book to another. Pat Conroy is obsessed with Charleston and the South, John Grisham is obsessed with renegade lawyers who risk their lives fighting evil attorneys, Lee Childs, in the form of Jack Reacher, is obsessed with the freedom that comes from not being attached to any possessions, except his toothbrush.

Using obsessive thoughts and harnessing them as writers is a means of hooking into our passion and using it in a positive way. How else can a person sit down and spend months and years writing unless they really care about the subject and the person they are writing about?

Art Smukler is an award-winning psychiatrist and author of Chasing Backwards, a psychological murder mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear. All are available as paperbacks and eBooks.

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ISIS (The terrorist Islamic state) finally got our government’s attention. Their blatant, vicious beheading of journalist James Foley was so in our face that no one could ignore for one more second what is happening in northern Iraq and Syria, and in fact all over the Middle East.

Just like President Obama, most of us are reasonable people and feel that everyone should be treated fairly and their beliefs respected. That idea of fairness is flawed when one is dealing with Islamic terrorists. Nothing they say or do can or should be believed. Their goal is to destroy anyone and everyone who doesn’t conform to their ancient cancerous ideas.

It’s no wonder that we suspect and fear the motives of all believers of Islam. Why did it take so long for the president of Indonesia to say publicly that these terrorists bring shame to all sincere, caring Muslim believers and that Islamic leaders should unite in attacking extremism? Why haven’t these leaders done something?

Why aren’t millions of “good” Muslims speaking out against the twisted “evil” Muslims? Why aren’t the millions of american Muslims marching with american flags in anger and horror at what is going on in the Middle East and supporting freedom and women’s rights? Is their silence affirmation and tacit agreement with the terrorists?

Fear? Reprisal? Insecurity?

Maybe. But at some point, a people must stand up for what they believe in. Just like in the sixties when activists marched for the rights of blacks in this country, why aren’t Muslims marching in support of american values and against Islamic terrorist values?

Finally, our president is doing what needs to be done. Terrorists must be stopped. We are at war for our very existence. Another Hitler has emerged and someone has to stop him.

Why should a psychiatrist have any special insight into the mind of a terrorist? I deal with people who are motivated to look into themselves on a daily basis. Who better to have an opinion regarding people who have no interest in examining themselves and are determined to kill people who don’t agree with them…

Art Smukler is an award-winning psychiatrist and author of Chasing Backwards, a psychological murder mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear. All are available as paperbacks and eBooks.

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SHOULD ALL PSYCHIATRISTS CARRY GUNS? by Art Smukler, author & psychiatrist

“Yo Dumplin. I’m home,” I called, swaggering into our ranch house. I swaggered because my sidearm, a Colt 45, weighed heavy on my right hip and made me walk funny.

“My hero,” Dumplin said, smiling, and dressed in a black bustier and long white skirt. “100,000 followers tweeted that you brought down another paranoid psychotic who would have killed dozens if you hadn’t taken brave and immediate action.”

“Aw shucks, sweetie. It was just in a days work. If the ACLU hadn’t called me a psychiatric Neanderthal and sued me and the hospitals hadn’t released my patient after 24 hours I wouldn’t be a hero. It was just dumb luck. Timing is everything.”

“You are so brave. I made your favorite vittles, spaghetti in a light, Bolognese sauce and a glass of 2007 Pinot Noir.”

Actually none of this is really funny.

The Community Mental Health system, which was started in the sixties, only succeeded in closing our state hospitals and filling our streets with untreated schizophrenics, bipolar disorders and paranoid disorders. Most are peace abiding but there are a percentage who are obviously dangerous.

What just happened at Fitzgerald Mercy Hospital in Philadelphia is horrifying. A man with a history of violence shot his social worker in the head, killing her, and wounded his psychiatrist, Dr. Lee Silverman. Dr. Silverman was able to use his own weapon and wound the assailant, who was then disarmed by colleagues.

When questioned, the police chief said that, “without a doubt, I believe the doctor saved lives.”

So; should mental health professionals start packing?

Most of the time, no. The chances of us shooting ourselves is a lot higher than hitting an assailant.

On the other hand, if one works with dangerous felons, that’s a different story. Maybe small arms training isn’t such a bad idea. Dr. Silverman made the correct and courageous decision, saving his own life and the lives of his colleagues.

I’m just waiting for the hospital, the ACLU or the assailant’s family to sue Dr. Silverman because he broke hospital protocol and carried a weapon. Sometimes I have a lot of trouble figuring out who’s crazier, the patients’ we’re trying to help or the people trying to protect these same patients from our ministrations…

Art Smukler is an award-winning psychiatrist and author of Chasing Backwards, a psychological murder mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear. All are available as paperbacks and eBooks.

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Children are often willful, out of control and want what they want when they want it. Trying to reason with a two-year-old is pointless. Firm, reasonable limits need to be set. Naturally, the child is enraged, but soon he understands that he can’t run into the street because he might get hit by a car, and he can’t punch his baby brother just because he wants to.

Our position in Iraq is somewhat similar to dealing with a two-year-old who refuses to listen. The US stance is that there must be a coalition government formed with both Sunnis and Shiites. Prime Minister Nouri Al-Maliki has refused and appears committed to a Shiite Iraqi leadership. What should we do?

The more all of us learn about this ancient Islamic conflict, the more we get how logic won’t prevail. And now Iran and Syria are supporting their new best friend, the Iraqi Shiites, to eliminate the Sunni insurgents. Oh, and aren’t we doing the same!

If reason won’t prevail, we should do what we’d do with a two-year-old. Set limits. Pull our advisors out of Iraq and let the prime minister, or whoever replaces him, do whatever he wants — but without us.

If we only knew how complicated the issue between the Muslim rival factions was, chances are we would have found another solution to the “weapons of mass destruction” other than invading Iraq. But, NOW WE KNOW! Let’s use this knowledge and not get any more soldiers killed or maimed for a cause that just won’t respond to reason.

If people are determined to die for their religious beliefs, the least we can do is stay out of the line of fire. Let’s get our own House (of Representatives and Senate) in order. We have our own out-of-control two-year-olds who won’t listen to reason.

Art Smukler is the award-winning psychiatrist and author of Chasing Backwards, a psychological murder mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear. All are available as paperbacks and eBooks.

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Iran has offered to help the Iraqi government fight the Sunni insurgents. The US is considering helping the Iraqi government fight the Sunni insurgents.

What? Am I going crazy? Do I need to lie down on my own analytic couch? Am I hallucinating and in need of medication?

Is this the same Iran that has promised the destruction of Israel and refuses to stop developing the capacity to make nuclear weapons?

Maybe I’m spelling it wrong? I R A N.

Nope. I just Googled Iran and it’s exactly the same country.

Well, it’s a relief that I haven’t regressed into a psychotic state. It’s not a relief that my country, that I love, has lost its moral and logical way.

As a psychiatrist, values and consistency are very important. If I were treating the leaders of our country (group therapy with the president, VP, Secretary of State, secretary of defense and the leader of the house and senate) I’d focus on one glaring fact, they are all political prostitutes. Oil rules, guns rule and votes rule. Money, like the amounts that the Koch Brothers have, can buy a lot of political commerce.

The refusal for the Republicans and Democrats to reason with each other is not unlike the inability of the Sunnis and Shiites to reason. Of course the Republicans and Democrats don’t go around killing each other, but they do force our government to shut down and create chaos in the world markets.

The answer? Clarify the values our country should support and live by them. Wait… Aren’t we the same country that supported slavery for 300 years?

Maybe I do need my couch…to take a nap. Maybe this whole thing is just a dream, well actually a nightmare.

Art Smukler is the award-winning writer of Chasing Backwards, a psychological murder mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear. All are available as paperbacks and eBooks.

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I can’t help but give my two psychiatric cents regarding the drama between Donald Sterling and the NBA.

Donald Sterling made private racist comments to his friend V. Stiviano that became public. The NBA commissioner, Adam Silver, heard the racist comments and started the process to fine Sterling 2 1/2 million dollars, ban him from the NBA for life and force the sale of the Clippers. Sterling’s wife Shelly, played point guard, in conducting the sale. The suitors, all very, very rich gave their pitches and the winner was Steve Ballmer, former Microsoft CEO who offered 2 Billion dollars. Just to put that 2000 million dollars in perspective — the total amount wagered when California Chrome ran in the Belmont Stakes was a mere 97 million.

So it’s all set, right? Steve Ballmer rewards the Sterlings with 2 Billion dollars (1500 million more than the highest price ever paid for an NBA team).

Wrong! Donald Sterling changes his mind. He feels his constitutional rights have been violated and he is now suing the NBA for a billion dollars and refusing to sell the team.

So why should a psychiatrist care one way or the other about all this drama?

I agree with Mark Cuban, a billionaire NBA owner and entrepreneur. He didn’t much like or agree with Donald Sterling’s racist comments, but felt that invading private thoughts and feelings and punishing them is wrong. If given the right to vote, he would have voted against taking the team away from Donald Sterling.

In psychotherapy, the basis of treatment is the ability to say and experience all sorts of feelings. No editing allowed! Anger. Hate. Love. Venom. Lust. All feelings are allowed. Acting on the feelings is not allowed! Without a safe harbor the process of psychotherapy can’t work.

Donald Sterling wasn’t in therapy, at least not with me, but he did make his racist comments in private.

Here’s my fantasy of the ultimate payoff.

Steve Ballmer immediately withdraws his offer. Players refuse to play for the Clippers. Fans refuse to pay one cent to fill the Sterlings pockets and the seats at Staples go empty on game day, and the Sterlings lose hundreds of millions of dollars in a protracted lawsuit with the NBA.

Donald Sterling can have all the private thoughts he wants. We just shouldn’t give him our money or our respect.

If he wants to make amends, let him donate a billion dollars to the LA school district.

Art Smukler is the award-winning writer of Chasing Backwards, a psychological murder mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear. All are available as paperbacks and eBooks.

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“LOOKIN’ COOL, BUT A FOOL…” THE MYSTERY OF MENTAL ILLNESS, by Art Smukler, author & psychiatrist

I looked in the mirror and nodded. Yeah, I really liked my jacket and wool cap. It was chilly this morning, but with the new additions to my wardrobe, I’d be warm and look good.

Minutes later, I was browsing the window of Barnes & Noble when a homeless man, pushing his cart filled with all his possessions shoved into plastic bags, announced loudly, “Lookin’ cool, but a fool”.

Shocked, I stepped away from the window and watched as the man shuffled past. “Jesus”, he was talking about me! I glanced at my reflection in the store window and shuddered. How did he know? I was feeling so full of myself this morning, and the old guy picked right up on it. It was brilliant.

It’s uncanny how some untreated schizophrenics have the intuitive skill to read our minds. Like a psychiatrist uses his “third ear” to pick up hidden nuances in psychotherapy, the schizophrenic can be even more acutely in tune to another’s inner workings.

To me it is absolutely amazing and mysterious. Sadly or happily or whatever one’s perspective, when treatment is successful, the magic fades — as do the voices and paranoid ideas.

Before they’re treated, how do psychotic people do it?

Probably being paranoid, with all senses on alert, allows the primitive, reptilian part of the brain to pick up and decipher the hidden thoughts of all potential attackers. The biochemicals in the brain align just so and magic happens.

I loved my first year of psychiatric residency when I was surrounded by untreated schizophrenics. I loved the mystery and the magic. I loved all aspects of how the mind works.

I still do…

Like mysteries and magic? Check out Chasing Backwards, a psychological mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear.

Dr. Smukler has won the prestigious Golden Ear Award for excellence in teaching at Harbor-UCLA Medical center and excellence in writing fiction at The Santa Barbara Writers Conference.

All books are available as ebooks and paperbacks. You can find them at or

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Did you know that according to Fox Business, the US has given Pakistan over 18 billion dollars in aid since 9/11?

Are you aware that Pakistan not only protected Bin Laden for years, but is currently executing people for blasphemy. Eighteen people are on death row. The “logic” behind all this is that every religious group in Pakistan supports the laws because Allah should never be disrespected. Obviously, the government is supporting the religious groups. Examples of blasphemy can include architectural design, throwing away a calling card, spelling errors and yes, disagreeing with someone in power regarding religion.


What does this have to do with psychiatry?

A basic rule in psychotherapy is that a patient must learn that thoughts are not equal to actions. Because you have violent thoughts about your parents, siblings, friends or even Allah doesn’t mean you are going to DO anything violent.

We have the right to our own thoughts. We don’t have the right, within reasonable law, to act on our violent thoughts. That’s why the prisons in California are overflowing. People broke the law by their actions — NOT THEIR THOUGHTS!

The actions of our elected officials is beyond logic. 18 billion dollars to support religious oppression and an anti-democratic way of life?

Yes, I know, it might be worse if we didn’t give them the money. How do we fight terrorism effectively? It’s a complicated issue…

Maybe it’s not as complicated as we are led to believe. Give money to a country who allowed Bin Laden to live in hiding? Give money to a government that doesn’t respect women’s rights, religious rights, or children’s rights?

If we used all that money to start rebuilding our own infrastructure, put everyone to work, and created as much of a petrol free environment as possible, we’d be a lot better off than pandering to countries who do not respect our values. Countries can have any values they want, but if they continue to keep their people oppressed, they can get their money from other oppressors, like the Saudis or Iranians. And good luck with that!

Art Smukler is the award-winning writer of Chasing Backwards, a psychological murder mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear. All are available as paperbacks and eBooks.

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WHAT’S ONE KEY THING YOU CAN DO IF YOU’RE DEPRESSED? By Art Smukler, author & psychiatrist

Feel melancholy, out of sorts, tired, cranky, a lack of energy, no enthusiasm, a sense of doom, a negative attitude, wake up early in the morning and can’t fall back to sleep, don’t feel like reading, writing, playing golf or any of the hobbies that you usually love?

Any of the above can be a sign of depression.

Should you immediately call your family practice doc for an Rx of Prozac or for a psychiatric referral?

I wouldn’t. Not yet…

I’d take some time to think about what’s going on in your life. Carefully go over the last few days before the symptoms started or got worse. What did you do? Who did you talk to? Did a friend or family member say something that hurt your feelings? Were you rejected? Left out? Disrespected?

The key underlying feeling that often triggers depression is ANGER.

Not expressing anger is usually the problem.

In therapy, a common dynamic in chronic depression is years of repressed anger. Parents who don ‘t have the time or inclination to help their children express themselves foster the development of kids who are continually sad. These sad kids grow up to be sad adults who wind up on therapists’ couches.

Together the therapist and patient work to discover what happened to cause the problem. Eventually they learn all about the repressed, hidden anger that has been a constant unwanted companion.

Self-analysis can be extremely helpful. If you discover who made you angry and deal with it appropriately there’s a good chance your mood will lighten and your energy will return.

Talking to the person who hurt you can often make you feel better. Sadly, you sometimes learn that the person you thought was your friend is insensitive and incapable of accepting responsibility for their hurtful actions. If they can’t change, you might need to find a new friend.

Resolving issues with a parent is more complicated. You can’t get a new one, but you can accept your mother or father’s limitations. You’re not obligated to take their words or actions to heart. Just because they think they’re right, doesn’t mean they are right. There’s a good chance your perspective is more accurate and helpful to the way you want to live your life than their perspective.

Whatever happens, dealing with your anger, can be very, very helpful.

Agree? Disagree? What do you think?

Art Smukler is the award-winning writer of Chasing Backwards, a psychological murder mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear. All are available as paperbacks and eBooks.

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