The patient before me is seventy years old.  She wears enormous starlet sunglasses and a sleek pageboy wig.  Her mouth is pursed, plaintive.  As we talk she touches her wig every few minutes and apologizes repeatedly for her appearance, which gives no cause for apology other than that… Read full post »

The young woman who sat before me seemed childlike in her baggy sweatshirt, her gaze inscrutable beneath long lashes.  Her story was a common one, though, like all human stories, unique in its details.  In her case: The long-distance relationship.  The unexpected visit.  The empty/… Read full post »

“Doctor, I’m afraid I might have ruined my brain.” Mr D’s wide brown eyes bore a pleading expression.  He was a young law student with a cherubic dimple set in his left cheek.  He had had no history of psychiatric issues until six months prior to our appointment… Read full post »

(The characters sketched in this piece are composites of several individuals I’ve  encountered in my training and my life.  They contain elements of real patients and acquaintances but do not represent strictly true accounts of specific people.)

The couple who walked into my office for… Read full post »

Imagine you are getting your car serviced.  You bring it to the shop, you get an estimate.  When the work is done the shop presents you with a bill.  It may be a little more or less than the estimate was, but either way that's what you'll be paying.  Now imagine… Read full post »

You came into the hospital hoping to deliver a baby.  In fact you weren't pregnant, but you wouldn't believe that; so the ER called me.  We had a pretty nice conversation.  I didn't challenge your belief that you were pregnant despite a negative urine pregnancy test and an ultrasound… Read full post »

The screech of my pager jolted me from sleep. A soft-voiced nurse informed me that they were having some trouble with one of the patients and his behavior was very disruptive to the others, so could I come by and see him, please?

I asked for some further details. Apparently he was… Read full post »

A new patient walked into my psychopharmacology clinic recently. She seemed not unusual at first. A line in the chart noted that she was somewhat wary of psychotropic medications, but then many patients are, and I don't mind that attitude since I also subscribe to the less-is-more theory of psychiatr… Read full post »

One of my more interesting recent cases was that of a young gay man who came to us in despair because he was in love with his heterosexual roommate.

 The two of them were extremely close: eating dinner together, going to movies, and generally engaging in very couple-like domestic activities.… Read full post »

  Mr W, a first-break schizophrenic in his twenties, had looked just terrible on initial presentation.  Flat, near-mute, meeting all efforts to initiate discussion with "No comment," or just a hostile wall of blankness.  Gradually the medications began to work their magic and he b… Read full post »