MEDICATION? AN ANSWER OR A CURSE? by Art Smukler MD, author & psychiatrist

Posted on May 31, 2020 by

Just recently, a patient who I hadn’t seen for decades, responded to one of my posts with a scathing rebuke of me, psychiatry, and the overuse of medication. He felt he was mistreated with drugs, psychiatry in general, and me in particular – a know-it-all attitude – that caused him enormous pain and suffering.

I remember him well and knew him to be a caring, bright person, who certainly wouldn’t set out to be mean or devaluing without cause.

He challenged me to examine myself and my profession. After getting over the initial shock and sadness that he felt the way he did, I decided to do what he suggested. So here goes…

After my training, as a young psychiatrist (so long ago), I really believed that most problems could be solved with psychotherapy – making the unconscious conscious. In short, understanding repressed memories and feelings could lead to having the freedom to make real choices, not choices based on unconscious rules that were embedded at a very young age. For example: not being allowed to hate a loved one often led to unconscious anger and subsequent depression.

It took a few years in practice for the realization that “talk therapy” could be very helpful for many patients, but not all. Schizophrenia, Bipolar Disorders, severe depressions, overwhelming panic disorders etc. almost always needed the use of medication. Miracles occurred. People who suffered for years, got better when the right medication was prescribed. Sadly, the miracles didn’t always happen. More often, a combination of psychotherapy and medication was helpful, but not perfect.

In fact, the practice of psychiatry is not perfect. Antidepressants work in only 66% of patients. Antipsychotics are helpful but there is no cure for Schizophophrenia. Mood stabilizers are necessary in bipolar disorders but there is always the chance of a reoccurrence of symptoms or side effect from the medication. Anxiety disorders (panic disorders, OCD, general anxiety) could get some relief from anti-anxiety meds, but there is always the danger of addiction, side effects, and break-through anxiety and/or symptoms.

What in life is perfect? Unspoiled Nature? First love? A really good pizza? But, even with these, there’s a long list of hazards.

Then there’s psychotherapy… The therapist uses his/her own feelings, intellect and experiences to help a patient understand what unconscious thoughts and feelings might be lurking within his mind. Since no one (even Donald Trump) is perfect, you can readily imagine that neither are therapists (no matter how well trained and dedicated). THERE IS NO PERFECT! So sometimes therapists fail.

Yet, and back to the original question, are medications (and I’ll add the whole profession of psychiatry to the equation) as terrible as my ex-patient expressed? For him, and I still feel badly, it was not helpful.

For others, I still believe, even after all these years, that it is the best thing that we have. One day, with genetic engineering or who knows what, it will be better.

So what advice do I have, given the state of the art?

Be brutally honest with your psychiatrist.

If a medication doesn’t work, it doesn’t work.

If your therapist interprets something that you disagree with, DISAGREE!

State your mind.

Do everything in your power to honestly clarify your feelings and ideas.

Never give up! If psychiatry doesn’t work, keep plugging away and search for another solution. Even with all our current strife, COVID, and whatever else we need to contend with, life without psychological pain can be wonderful.

If you enjoyed reading, Inside the Mind of a Psychiatrist, you might also enjoy Dr. Smukler’s novels – 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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EVIL IN THE WHITE HOUSE, by Art Smukler MD, author & psychiatrist

Posted on May 27, 2020 by

For quite a while, I’ve done the impossible – kept my mouth shut and my computer off with things pertaining to Donald Trump. But no more. I can’t tolerate his lies and the way that so many Republicans support and chuckle that what he’s doing is okay.

Everyday there is a new lie.

Everyday another person is attacked or fired for disagreeing with him.

Everyday he performs another outlandish action that hurts our country.

No mask. Get close. The virus is a Democratic disease blah, blah.

It’s sickening. I personally know a number of people who STILL support this manipulating sadist. I will not invite these people into my home. I can’t respect anyone who supports his brand of absolute utter disdain for the rules of law and accepts his abuse of power. If you support him, you condone name-calling, bullying, lying and on and on.

Will they care? Of course not. But I care!

If we don’t speak out against Trump – shame on us! His behavior and the behavior of his followers has created chaos and death.

Can you believe that he refused to allow a ship with COVID passengers to debark on our shores because IT WOULD MAKE THE NUMBERS HIGHER AND HE WOULDN’T LOOK GOOD. You can’t make this stuff up! He said it!

Even if you don’t agree with all the politics of Democrats, in all conscience please DO NOT SUPPORT Trump or his sycophants.

In the world of psychiatry not everything can be chalked up to underlying conflicts and the need to uncover unconscious motives. Spending even one second trying to reason with a psychopath is useless. I already know why Trump does what he does. Power! Greed! THE INABILITY TO EVER THINK OF SOMEONE BUT HIMSELF.

Whatever Trump says is a lie. That’s my new general rule and advice on how to deal with him. Even if his actual words are accurate, ALWAYS suspect his motivation.

If you enjoyed reading, Inside the Mind of a Psychiatrist, you might also enjoy Dr. Smukler’s novels, 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.

Posted in Bullying, Politics, Psychiatry, Self Examination, World events, a psychological view | Tagged , , , , | 10 Comments

WOULD YOU RATHER? by Art Smukler, author & psychiatrist

Posted on December 14, 2019 by

Do you remember the kid’s game, Would You Rather? Would you rather have pins in your eyes or your ears? Would you rather eat only hotdogs or only ice cream for a week? And on and on…

What came to mind is the true story of Jack, a grade school friend, who was charged with Medicare fraud. Jack was a GP and sentenced to six months in a federal prison. The prison happened to be located on the same air force base in Florida, where I was stationed as a major (a psychiatrist) during the Viet Nam era. One “interesting” experience was the time that the base rabbi “invited” the medical staff to join him and his family as they hosted a bagels and lox brunch at the prison. The rabbi was a colonel and his “invitation” was actually a direct order. That morning dozens of doctors and prisoners shared the buffet and surprisingly, it was a pleasant experience.

Jack was incarcerated a few years after I completed my tour of duty, but the same rabbi was still hosting his monthly brunch. I assumed that Jack took full advantage of this prison perk.
A few years later, a good friend told me that after Jack got out of prison he decided to get divorced, give up his medical practice, and start a new life. Jack said, “Those six months were the best six months of my life. I never realized how miserable I was until I was sent to prison. It took prison to help me understand what I really wanted in life.” The last I heard, Jack had moved halfway across the country and was living “happily ever after”.

Our lives are finite and if we don’t make the most of them we waste an irreplaceable commodity. As most cancer survivors have learned, every moment we are alive and comfortable is a treasure.

What we show the world is often just the tip of the iceberg. Our true selves are often hidden below the surface, undiscoverable to the world and often to ourselves. Not only do we have the chance in Plato (*) to learn about subjects that interest us, we have more disposable time and this gives us more time to learn and think about who we really are and what we really want.

How many people give themselves the opportunity to listen to their own thoughts, and explore their own feelings? Do you need to have the radio on when you’re driving? How often do you just drive in silence or just sit in silence, letting your thoughts fill the void? Do you think about your dreams and take a shot at analyzing them? Do you ask friends and spouses what they observe about you and then do you take what they say and actually think about it?

Luckily, we have a chance to think about ourselves without having to get divorced or have a bagel brunch with the rabbi. Would you rather be in prison or be divorced? I choose neither. I choose to live each day with the opportunity to try and understand what’s really important to me. I recommend that for all of us.

*Plato is an independent group associated with UCLA that is dedicated to lifelong learning. It attracts all ages and many professors, physicians, lawyers, teachers, engineers, and anyone who loves the thrill of learning new things.

If you enjoyed reading, Inside the Mind of a Psychiatrist, you might also enjoy Dr. Smukler’s novels, 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.

Posted in Psychiatry, Self Examination | Tagged , , , | 2 Comments

RETIRED? TAKE THE MOST UNIQUE, ONE-OF-A-KIND JOURNEY OF YOUR LIFE, by Art Smukler MD, author and psychiatrist

Posted on October 20, 2019 by

WHERE? A place no one but you will ever visit.

WHEN? Now… Tomorrow… Whenever you choose.

HOW MUCH WILL IT COST? No money. Only time and courage.

Yep, you probably are on the verge of guessing it — a trip back to your past.

What does this have to do with retirement?

Time. Freedom. Enough money to get by on. All the tools that most of us never had before.

Like Janis Joplin and Kris Kristofferson sang in BOBBY MCGEE, Freedom’s just another word for nothing left to lose, nothing ain’t worth nothing but it’s free. Feeling good was easy lord when Bobby sang the blues. Feeling good was good enough for me, good enough for me and Bobby McGee.

I’m serious. When else in your life have you had the time to just hang out with yourself? No worries about getting good grades. No worries about making the football or dance team, no issues with your parents, getting a date Saturday night isn’t a big deal — every night is like a Saturday night and on and on.

Time’s running out. Often this is the endgame. How long will it last? Who knows? Ten years? Twenty years? Thirty? Who cares? It’s out of our hands. No power to predict.

But the power we have is significant. FREEDOM!

Remember your first date? What did she look like? What did she say? What did he say? What did you say? First kiss? First love? First fight? First job? First time you ate pizza. You get the idea.

Settle down in your favorite chair, in bed, on a bike, Starbucks, on a long car trip…anywhere, anytime. Let your thoughts wander. Have the courage to remember…the good, the bad, the ugly… Hey, what a great title. You think anyone has ever used that before? Ha Ha

It won’t be easy. Sometimes the pain might well up, just as powerfully as it did so long ago. But, so will the love, and excitement, and sense that life is a continuum, and we can retrace our steps.

Why?

It’s a chance to reconnect with our past, with friends and experiences we haven’t thought about in years. A chance to relearn what was important and what might still be important. Maybe even a chance to do what you never did, to feel again what you thought was gone forever.

It’s not too late to take the trip of a lifetime.

If you enjoyed reading, Inside the Mind of a Psychiatrist, you might also enjoy Dr. Smukler’s novels, 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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LESSONS FROM THE CHAIN GANG, REFLECTIONS ON THE PAST, by Art Smukler

Posted on October 9, 2019 by

I belong to Plato, a group in Los Angeles devoted to learning. As the editor of the monthly newsletter, I was called upon to write my bi-monthly editor’s note. Given that today is Yom Kippur, a day of reflection, I thought it was a good time to share this story again on my blog.

Not too long ago, I decided to clean up and reorganize our backyard. We have a number of 50-year-old Spanish clay pots that were left by the previous owners and were sitting in the wrong places. Some of the pots easily weighed a few hundred pounds.

I did what any self-respecting psychiatrist-homeowner would do and called a half-dozen nurseries in the area. I explained the problem and most said they just didn’t come out to move pots. The one that said they could do it, wanted to charge enough for a weekend at a fancy hotel. So, the next morning I decided to do it myself.

First, I had to empty out all the pots. We’re talking about pots that stand over 4 feet high and 3 feet wide and filled with soil so old and hard that it felt like cement. Then I had to carefully move the empty pots, that still easily weighed over a hundred pounds, to their new location. It took almost two days of hard physical labor. A lot of shoveling, lifting, sweating and grunting.

Why does any of this matter? Gardeners do it every day.
Well I don’t and most of you don’t. This was the first time in many years that I did this kind of work.

It brought to mind my teen years and the many hours I spent working for my Uncle Bill in his auto accessory store. I was assigned to the “chain gang” in the dank basement, where I put together heavy links of chain to make snow chains. Hour after hour I’d work alone, measuring, hauling boxes of uncut metal chain, and cutting and crimping them together. Sweating and cursing to myself I’d work hard, knowing I’d be paid at the end of the day and would always have a hot lunch with the other workers, hosted by my uncle at the neighborhood Puerto Rican restaurant.

Then I’d return to the basement and the chains, wondering what my lot in life would be. Would I be doing this forever? What was going to happen to me when I grew up?

Well, sweating outside in my own garden brought back these poignant memories. I miss my Uncle Bill. I appreciate all the opportunities he gave me to learn the value of hard work and how it would help me for the rest of my life. I miss how he would sometimes come down to the basement, look at what I’d accomplished, and smile.

When parents don’t give their children the opportunity to work hard and earn their way, but just give and give without value for value, they aren’t helping. In fact, they are creating a person who often turns into an entitled, selfish individual. Hard work for fair pay should be the rule rather than the exception. Lunches should be earned.

I was also very fortunate that my uncle wasn’t simply a nice guy. He was also someone who enjoyed listening and doing his best to be helpful. He rewarded hard work with respect and love. It helped me raise my own family and become a good psychiatrist. It helped me become a person who starts a job and finishes it. It helped me become a member of Plato who enjoys the challenge of hard work and enjoys the profits that hard work produces.

Most members of Plato are retired or thinking about it.
One major advantage of retirement is the chance to remember the past. To reevaluate and do some of the things that time and the need to support yourself and your family didn’t allow. Enjoy and savor your memories. The past made us who we are.

Another recent experience that brought all these memories back was getting together , for the first time in many years, with my first cousin Larry, Uncle Bill’s son. He is a caring, thoughtful, retired judge. Who better to judge others than a man raised by a man who could always put himself in another man’s shoes?

If you enjoyed reading, Inside the Mind of a Psychiatrist, you might also enjoy Dr. Smukler’s novels, 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.

Posted in Psychiatry, Raising Children, Self Examination, Uncle Bill's Place, Writing | Tagged , , , , , | 4 Comments

POTUS IS NAKED or THE ADVANTAGES OF A MIND EXPOSED by Art Smukler MD, author and psychiatrist

Posted on September 21, 2019 by

We’re all sick and tired of hearing the story of THE EMPEROR’S NEW CLOTHES. Well, please, be a good sport for just one more time. It has a new satisfying twist. Ha. If you can’t have a good time writing for no money, there’s no reason to do it. So back to the story…

All the people in Washington, DC, I mean Republicans, are too afraid to tell emperor POTUS that he’s running around stark naked. Why? The emperor, a self declared stable genius, is an insecure, vindictive, little man who will retaliate if anyone confronts him or disagrees with him. A cold day means that there is no climate change. If you won’t sell Greenland to the USA you are a disrespectful enemy. Putin is a good man. More people came to Trump’s inauguration than Obama’s. Yadayadayada…

It’s a fact, not fake news, that the man is a pathological liar. So why, you ask yourself, is Art Smukler MD, a psychiatrist, boring me with a reiteration of everything we already know and hear about on CNN and MSNBC every day, all day?

To answer that very valid question, I’ll take a short segway back to my past. One of the most interesting and exciting things about psychiatry is the opportunity to learn about human nature and aspects of the mind. Learning about schizophrenia and bipolar disorders and their associated delusions, hallucinations, and manic episodes is like having an x-ray machine to examine the mind. In the psychotic state, all the defensive trappings are exposed. Politically correct words and behavior don’t exist. Add a bit of psychotropic medication and a supportive atmosphere and most of it goes back to normal.

So how does this relate to emperor Trump?

Seeing and hearing him is like having that same x-ray machine showing you all the aspects of sociopathy and a narcissistic personality disorder. You don’t have to go to medical school or take a psychiatric residency or pass your boards. Just listen to POTUS and you’ll learn everything you need to know about people you should ALWAYS stay away from. They will hurt you. They may be charming, rich, good-looking and hard to resist, but if you get involved, YOU WILL BE HURT!

POTUS is giving us a life lesson on who to avoid. All free without having to read and study and pass tests.

See, having a naked emperor running around the White House has its advantages.

If you enjoyed reading, Inside the Mind of a Psychiatrist, you might also enjoy Dr. Smukler’s novels, 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.

Posted in Childhood Trauma, Politics, Psychiatry, Self Examination, World events, a psychological view | Tagged , , , | 6 Comments

A PEP TALK FOR WRITERS, by Art Smukler, author and psychiatrist

Posted on May 2, 2019 by

Last night, Hillary Clinton said something on the Rachel Maddow Show that really struck a bell, more like a gong. She said, “I’m living rent free inside of Donald Trump’s brain, and it’s not a very nice place to be.”

Wow. For many of us, it’s just the opposite. The Liar In Chief, like an obsessive-compulsive-disorder, is living rent free in OUR brains.

So what does this have to do with writers?

Obsessions take up too much space. They stifle the creative process, and don’t allow for the tiny sprouts of new ideas to battle their way up from the darkness of our unconscious to the light of our computers. When the trillions of synapses in our brains are occupied 24/7 by injustice and greed, they short-out. Our ability to take the “road less traveled”, to ideas that we’ve never had, is severely limited.

Writing is our food and oxygen. Without it, we wither and gasp.

Take a Trump break.

Flush him.

If you can’t nourish yourself, you won’t have the strength to nourish others.

Write. Rewrite. Write!

A fully satiated writer has a better chance of going viral and winning back our democracy…

If you enjoyed reading, Inside the Mind of a Psychiatrist, you might also enjoy Dr. Smukler’s novels, 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.

Posted in Politics, Psychiatry, Self Examination, World events, a psychological view, Writing | Tagged , , , , | 1 Comment

WHEN TRUMP DIES, WHERE WILL HIS SOUL GO? by Art Smukler MD, author & psychiatrist

Posted on April 7, 2019 by

I don’t believe in god or a higher power or that one religion is superior to another religion; so for me, the term soul is used in a philosophical manner.

What does the afterlife hold in store for a man who lies, cheats, boasts, enjoys prostitutes and says it’s not true, uses the US presidency to enhance his wealth, never served in his country’s military for a “trumped-up” reason, bullies and has a wife who runs an anti-bullying bullying campaign, pretends to win golf championships, name calls, colludes with autocrats from Russia and Saudi Arabia, is a bigot, a racist and the most narcissistic man to ever hold the office of POTUS.

Where does his soul go?

It goes to the gilded, empty, cold, Trump Tower, where everything a man touches turns to gold. No warmth, no love, no cookies and milk, no little puppies to lick your face, no fond memories of people you’ve loved and sacrificed for, no warm summer days where the balmy breeze tickles your face and blows your hair, no Snickers bars, no gentle caresses, no warm baths, no loving gazes, no sense that your life helped the needy and under-privileged… only ice-cold-gold.

Welcome to your future Mr. Trump.

Oh, and one more thing. There’s a thousand-foot-high-wall that surrounds your final condo resting place. It was built by all the money you stole from people who believed you were an honest man.

Posted in Bullying, Childhood Trauma, Politics, Raising Children, Self Examination, World events, a psychological view | Tagged , , , , | 10 Comments

WHAT’S THE SECRET REASON PEOPLE EITHER HATE OR LOVE TRUMP? Art Smukler MD, author & psychiatrist

Posted on February 17, 2019 by

Like the main part of an iceberg, hidden from view under the dark icy water, our unconscious mind, hidden from consciousness by defenses like denial and repression, is the real bulwark behind our feelings and actions. Freud theorized that access to this powerful, yet unconscious force, can be reached through our dreams, slips of the tongue, symptoms like depression and anxiety, and subtle feelings and actions, that can give clues as to what’s really going on in our minds.

When Freud used psychoanalysis, a patient could let his mind wander and say whatever thoughts popped up in his head. One thing might lead to another and a patient would finally understand that his depression was triggered by an underlying anger toward a parent or a sibling that he was too ashamed or guilt-ridden to admit.

Trump’s lack of an editor, saying whatever he wants whenever he wants, is like watching someone on the psychoanalytic couch. We all watch him on national television lie, name-call, manipulate, bully, bribe, all with the purpose to gain enormous riches and more power.

Wouldn’t most of us want all that power?

Wouldn’t it be really cool to have a few billion dollars sitting in a hidden bank account and never having to disclose where the money came from? Maybe even Russia…

How about owning a bunch of hotels and mansions instead of always trying to negotiate a good rate at a hotel?

How about denying the truth and almost always getting away with it? I didn’t take the cookie! I paid all my taxes! Honest!

How about hiring someone to fix your house? If they don’t like not getting paid, too bad. They can sue!

And on and on…

The truth is that most of us still have feelings and desires that go all the way back to our childhood. BUT, as adults, these desires are tempered with a desire and a need to help others and be good people.

So what am I saying?

I’m saying that Trump’s impulsive, out-of-control behavior, and outlandish statements tap into our unconscious selfish feelings. By definition, unconscious means we don’t know what we’re feeling, so we react to Trump’s behavior with a bigger than life reaction.

Sadly, Trump is constrained by nothing!

He poops where he wants and listens to no one. A wild two-year-old is the leader of the free world. “I want what I want when I want it!”

Fourteen years ago, my grandson, then a two-year-old, was playing in the park with a bucketful of sand toys. Another little boy wanted to play with the toys, but my grandson made it clear that they were his toys and he didn’t want to share. I walked over to him and said, “How about sharing with this nice little boy?” My grandson, with a somewhat guilty expression, said, “Poppy. I’m sorry, but I’m not a good sharer.”

So, even a two-year-old can have feelings of guilt about not considering others. By the way, my grandson is now sixteen, and is one of the nicest most caring people you’d ever want to meet.

Maybe our president is emotionally just one-and-a-half years old…

If you enjoyed reading, Inside the Mind of a Psychiatrist, you might also enjoy Dr. Smukler’s novels, 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.

Posted in Bullying, Politics, Psychiatry, Raising Children, Self Examination, World events, a psychological view | Tagged , , , | 3 Comments

THE BRILLIANT LESSON DONALD TRUMP TAUGHT US, by Art Smukler MD, author & psychiatrist

Posted on December 6, 2018 by

Who wouldn’t want 10 billion dollars?

I would. Then when the market tanked I’d still have a few billion left for coffee at Starbucks and gasoline, even if we dumped the immoral Saudis.

So what did the great man teach us? It is the same lesson that we were all taught as kids… Money can’t buy happiness or class.

To be frank, there were times I didn’t believe it, but I forgot two important facts. I’ve always had friends, and I never enjoyed hurting others. In fact, the value of helping others is often immeasurable.

Just look at the way other world leaders, including fellow United States Presidents, act around this man. They can barely hide their contempt. Let’s think about it. Contempt is a good word for someone who thinks he can bully and buy his way to respect and dignity. IT DOESN’T WORK.

I get it that in 2016 a third of our country was desperate for a change that would get them a decent wage and a means to support their families.

Well, what they got was a guy who only pretends to care about those who voted for him. Ask the working guy if the tax break helped. Ask GM workers if the job promise worked… Ask Dreamers if he helped them? Ask his good friends Michael Flynn and Michael Cohen how they feel about being threatened for telling the truth. And on and on…

But hopefully most of us still have what Donald Trump is incapable of having – good friends, dignity, and an approach to life that includes respect for others and the ability to share love.

If you enjoyed reading, Inside the Mind of a Psychiatrist, you might also enjoy Dr. Smukler’s novels, 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.

Posted in Bullying, Politics, Self Examination, World events, a psychological view | Tagged , , | 1 Comment