AI had taken over health care

Peter Simons writes in his article "Doctors: Patients Don't Want You To Use AI" on 08/18/25 on the Mad In America website:

There’s a deep divide between how patients and doctors view the use of artificial intelligence (AI). Doctors are overwhelmingly in favor of using AI: two-thirds of doctors have already incorporated it into their practice. But patients are concerned about AI’s tendency to make up false information and fear AI use may further reduce an already dismissive and unsympathetic medical interaction to something completely robotic.

This divide exists in other fields too, where corporate executives believe that AI has improved customer service, but actual customers disagree, with 88% preferring human interaction, and almost half say “their biggest frustration has been not being able to reach a human.”

The back room jargon in the health care field is the importance of treating the record and not the patient. Modern health care has turned into disease management and less on patient care.

How to manage this poor patient care? Limit your interactions with health care professionals which are increasingly being recorded and be careful about the information you share. Find other resources for understanding and support.

Book Review - The Book Of Ruth by Jane Hamilton

While it's not a self-help book, reading Jane Hamilton's The Book of Ruth can offer several psychotherapeutic benefits, primarily by fostering empathy and providing a powerful narrative for exploring themes of trauma, resilience, and personal growth. The novel is not a manual for therapy, but it can serve as a catalyst for self-reflection and understanding.

Here are some of the potential psychotherapeutic benefits of reading The Book of Ruth:

• Empathy and Understanding of Trauma: The novel provides a deeply personal and raw account of a character, Ruth, who endures a life of hardship and emotional abuse. By immersing yourself in her perspective, you can develop a deeper sense of empathy for individuals who have experienced trauma, particularly those from marginalized or difficult backgrounds. Ruth's story challenges the reader to look beyond surface judgments and understand the complex reasons behind her choices and struggles.

• Exploring Family Dynamics and Cycles of Abuse: The book's central conflict revolves around the toxic and abusive relationship between Ruth and her mother, May. By witnessing this dynamic, readers can gain insight into the destructive nature of family dysfunction and the ways in which trauma can be passed down through generations. This can be particularly therapeutic for readers who have their own difficult family histories, as it may provide a framework for understanding and processing their experiences.

• The Power of Resilience: Despite the immense suffering she endures, Ruth demonstrates a quiet yet profound resilience. She finds solace and strength in unexpected places, such as her correspondence with her aunt and her love for literature. Her journey from passivity to a form of self-rescue highlights the human capacity to survive and even grow in the face of overwhelming adversity. This can be a source of hope and inspiration for readers facing their own challenges.

• The Quest for Identity and Self-Worth: A major theme of the novel is Ruth's struggle to define herself outside of the expectations and labels placed upon her by her family and community. She is constantly told she is a "loser" and is overshadowed by her "brilliant" brother. Her journey of self-discovery, from a timid and passive young woman to someone who can piece together her own story, is a powerful narrative about finding one's voice and recognizing one's own value.

• The Role of Narrative in Healing: The novel is revealed to be a story that Ruth herself has written. This framing device suggests that the act of telling one's own story can be a form of therapy and a path to forgiveness. By creating her own narrative, Ruth is able to process her trauma and take ownership of her life. This can be a powerful lesson for readers about the importance of giving voice to their own experiences.

In summary, The Book of Ruth offers a harrowing but ultimately hopeful look at the human spirit. While it's a work of fiction, its exploration of themes like trauma, family relationships, and resilience can serve as a valuable tool for introspection and empathy, providing a unique form of psychotherapeutic benefit.

Violent attack on CDC goes largely unnoticed

“It’s been a struggle to process what happened at the CDC just a few days ago. The facts are coming in: one officer died, 500 rounds fired, 200 bullets made contact with 6 CDC buildings, hundreds of staff sheltered in place for hours. The intention is undeniable: this was an attempted massacre.”

This was the opening of an August 13 Substack column and video discussing the deafening silence after the deadly attack last week on the Centers for Disease Control and Prevention in Atlanta, a joint effort by resident physician Kristein Panthagan, emergency physician Megan Ranny (also Dean of Yale School of Public Health) and epidemiologist Kateyn Jetelina of Your Local Epidemiologist.

“The state of the world feels unrecognizable,” they wrote. “We are living headline to headline, tragedy to tragedy…Our world is swallowed whole by the endless churn of violence and crisis we’ve come to accept as ordinary. We are drowning in the abnormal…”

In a LinkedIn post, Jeletina wrote: “As horrific as it was to have 500 bullets fired toward the CDC, what’s been equally painful is what followed (or rather, what didn’t). The silence. The indifference. It's been deafening. Especially after all that public health has given over the past six years.”

For more click here.

The CDC has done great work in making the public health of Americans better than it would otherwise be without their good work. However the attacks by MAGA, DOGE, and Robert F. Kennedy, Jr. have cultivated animosity, and vilification by the scientifically illiterate who resent limits being put on their life threatening behaviors.

Our society will enjoy a higher quality of life for all if we support our public health programs.

Female veterinarians have a suicide rate 3.5 times the national average.

Parenting - Predictability nurtures secure children.

 

One of the key components of mentally healthy functioning is security. Security comes from predictability from the perspective of the child. Can the child trust their caretakers to meet their needs and treat them fairly?

Does the parent mean what they say and say what they mean? Is the parent reliable and dependable? If so, the child grows up feeling secure and competent in meeting life's expectations and requirements.

In structural family therapy the therapist focuses on the family hierarchy, good boundaries, regulated management of emotional expression, and the provision of predicted routines. This means that the therapist often parents the parents so they can better enact their parenting roles with their children to achieve more satisfying and fulfilling family relationships.

Parents should not say things to children they don't mean and aren't likely to follow through with. Honesty is a significant virtue to cultivate in ourselves and in our relationships.

Do chat bots cripple social skill development in children and teens?

 

For more from this Scientific American article click here.

There are similar concerns about the crimpling of human social skills when people resort to on-line social media to meet their needs for social connection.

Parenting - telling the children about the plan to divorce

 

Linda McCullough Moore's book of short stories, An Episode Of Grace, begins with the story entitled, "You choose," which begins with this paragraph:

"I’m driving on Route 91, going ten miles over the limit, on the way to my divorce, or, at least, to its announcement. My husband Jake and I decided we would tell the kids tonight. We’ve waited way too long. Our marriage died of natural causes years ago. We are planning that our children will be shocked beyond surprise, but we both know better. Any hesitation that we have about telling them isn’t fear of their surprise; it’s knowing that once we say the words, out loud, to them, it will be official, carved in stone, irreversible. But, of course, that’s what we want."

The children's' names are Jonah who is 11 and Adam who is 6.

Of all the questions I get asked as a couple counselor and a family therapist by people going through a divorce are when and how to tell the kids?

My stock answer is "Don't tell them anything until you know specifically what the plan is unless they ask."

Kids being narcissistic in a healthy way first ask when told their parents are separating is "What's going to happen to me?" Parents need to have the answer to provide the child with whatever sense of security and predictability they are able.

The narrator in this story has her plan in place and has coordinated the telling the children with her husband and as she travels to the meeting with the children she gets stuck in a snow storm and as the various events unfold her ambivalence about divorcing her husband grows in poignant ways.

The ambivalence partners usually feel about a break-up with the concomitant anger, sadness, fear, hope, sense of failure and regret, are things the therapist witnesses and, hopefully, clarifies with the client(s) into some sort of coherent story that makes sense to themselves primarily and then to others affected.

The key question, often overlooked, in the emotional turmoil is, "What is the purpose of this relationship?" The genuine answers to this question usually lie at an unconscious level that the individual is not aware of and doesn't understand. 

The understandings of one's motivations, choices, and responsibilities are key to growth towards greater maturity so that the individual does not jump from the proverbial frying pan into the fire and engage in what Dr. Freud called the "repetition compulsion" to merely re-enact the same scenario over again.

The narrator of the story recognizes that telling the children about the impending divorce is a milestone in the process which she determines as a point of no return. It is an action which will make the rupture permanent and complete. The finality and the closure seems to heighten her apprehension about the decision to divorce rather than mollify it and liberate her.

What will she do when she gets her car unstuck from the snow and reschedules the meeting with her their husband and maybe soon to be ex- husband?

Pop quiz - Parenting styles

What is the most effective parenting style?

A. Authoritarian

B. Permissive

C. Uninvolved

D. Authoritative

For more click here.

New York State has third lowest suicide rate in the US after New Jersey and Massachussetts.

 Based on recent data, the suicide rate in the United States is significantly higher than the homicide rate.

• Suicide Rate: In 2022, the age-adjusted suicide rate was 14.2 per 100,000 people.

• Homicide Rate: In 2023, the homicide rate was 5.9 per 100,000 people. Other data for 2023 shows a rate of 6.8 per 100,000 people.

In terms of total deaths, there are nearly two times as many suicides as homicides in the U.S. For example, in 2022, there were over 49,400 suicides compared to around 24,800 homicides.

In my career as a Psychiatric Social Worker I have done over 15,000 suicide evaluations most of them as a Psychiatric Assignment Officer in urban hospital emergency rooms.

Suicide rates vary greatly by region and other demographic characteristics. Men kill themselves three times more often than women but women attempt suicide three times more often than men. The reason for the discrepancy between suicide death rates is due to the means of the attempt. Men most often use guns while women use ODs and cutting.

New York State consistently has one of the lowest suicide rates in the United States. While the specific ranking can vary slightly depending on the year and the source of the data, New York is typically in the bottom three alongside states like New Jersey and Massachusetts.

For example, according to data from 2021, New York's suicide rate was 7.9 per 100,000 people, placing it among the lowest rates in the country. This is in stark contrast to states with the highest rates, such as Wyoming, Montana, and Alaska, which often have rates three to four times higher.

Suicide rates seem more influenced by the availability of social infrastructure than any other factor. When people are desperate do they have a place to turn? Is there help for what is distressing them so much that they would rather end their lives than go on living. New York, New Jersey, and Massachusetts have much better health and human services than other states.

Withdrawal symptoms from discontinuing antidepressants worse the longer they are taken

From PsyBlog 08/06/25

The longer a person takes antidepressants, the more likely they are to experience withdrawal symptoms when coming off them.

People who have taken them for more than two years are at a 10 times higher risk of experiencing withdrawal symptoms compared to short-term users (less than six months).

For long-term users, those symptoms are likely to be more severe and take longer to resolve.

Around half may suffer withdrawal symptoms when coming off antidepressants (although some think the true rate is nearer 15 percent).

Withdrawal symptoms include anxiety, dizziness, headaches, nausea, depression and suicidal thoughts.

It has been my experience after 56 years of practice as a psychiatric social worker that anti-depressant in some situations can be helpful but they are not a panacea for what too easily is diagnosed as "depression." There are many different types of depression and multiple factors that contribute to it. Studies show that in general counseling is more helpful in the long run than medications. In general anyone started on an anti- depressant should also obtain an evaluation of the depression by a qualified mental health clinician.

Themes from The Best American Science And Nature Writing 2024

The themes that have emerged for me from The Best American Science and Nature Writing 2024  are:

1. The earth is getting warmer and having negative consequences for the ecological balances which we humans have become accustomed to.
2. This climate warming is having negative consequences up to and ending in death for many living things.
3. A small group of under-supported scientists are studying what's happening and their findings are largely ignored or dismissed by the decision makers except in a few instances.
4. Science journalism is one way of informing and educating people about what is happening to them which is outside their level of awareness because the changes are insidious except when they culminate in catastrophic weather events.

Some observers have noted that because of these four things social anxiety and tension has risen contributing to political polarization and the rise of autocracies exemplified by the "strong man" leader who promises to "fix everything" and make people safe and more secure. This political solution is delusional because it doesn't address the underlying problem which is human caused climate change.

What will help? A correct diagnosis of the problem causing the rise in anxiety and plans that are effective in addressing the creation and maintenance of the problem. This requires cooperation, collaboration, and joint efforts around the planet. Isolation and nationalism will not help, but only maintain and increase the problem. There needs to be a shift from the emphasis on private wealth and profit to a sharing and creation of health giving commons. This is a huge shift in values especially in the richest country in the world, the US. What will bring this shift in values in the US population? The worsening of circumstances until people have to find a better way to live if they are to survive. And then a transformation into cooperative, collaborative, mutually satisfying democratic processes.

PS - The Best American Science and Nature Writing 2024 is the August 2024 selected read of the Allnonfiction Book Discussion Group. If you are interested in joining the Allnonfiction Book Discussion Group you can find more about it here.

Use of EHRs (Electronic Health Records)

Those of us with a more cynical sense of humor use to talk about "treating the chart". Treating the chart becomes more important as a means of complying with system expectations and requirements and often is used in measuring provider performance. This system is very dysfunctional and contributes to poorer patient care. As such, an argument might be made that the use of EHRs is unethical because of the skewed values and consequences for patient care.

When I reopened my private practice in May of 2024, I attempted to use the Simple Practice practice management system which includes their EHR templates. I quickly abandoned most of it because it seemed to interfere with my client care rather than enhance it. I went back to keeping my own notes on paper for the most part and sometimes computer based files which only I control and designed. The only thing I use it for now is billing.

https://mailchi.mp/openminds.com/daily-executive-briefing-4323228?e=f8bccd7a14

"most EHR systems weren’t built with the clinician in mind. They were built to get electronic billing information to payers and health plans and the results reflect those early designs. A study found that primary care practitioners spend more than 50% of their workday using their EHR—355 minutes (5.9 hours) of an 11.4 hour workday (see Primary Care Doctors Spend More Than 50% Of Workday On Documenting In The EHR). Of those 355 minutes, 75% were spent in the office during office hours and 25% were spent after hours. These data show that three tasks consume the most time: documentation (24%), reviewing chart notes (17%), and prescription refills and results management (16%)."

Teen suicide is on the decline, new federal data shows

From NPR on 08/04/25:

The new report shows that the prevalence of serious suicidal thoughts in 12-to-17-year-olds fell from nearly 13% in 2021 to 10% in 2024. And the prevalence of suicide attempts by teens also fell slightly — from 3.6% to 2.7%.
--------------
The report also found that the share of teens with an episode of major depression in the past year fell during this time — from 21% to 15%. But only about 60% of teens with a recent episode of depression got treatment.

And 2.6 million teens still had thoughts of suicide in 2024, notes Hannah Wesolowski, chief of advocacy with the National Alliance on Mental Illness.

"That's 1 in 10 kids, which is still far too high in this country," she adds. "So we're making progress, but we're not making progress fast enough."

The report also found that 700,000 adolescents did attempt suicide in the past year.

Access to treatment is still very difficult for most families due to lack of providers, poor insurance coverage, high co-pays.

I would hypothesize that the suicide rate will continue to decline due to the heightened awareness of the negative impacts of smart phone social media addiction and the limiting of smart phones in schools.

Keep the faith. Stay strong. Be courageous. Tell the truth. Do the right thing. Focus on what matters in an age of cruelty in the US.

The following article was written and published on davidgmarkham.substack.com on 01/26/25. Not much has changed other than the national well being deteriorating further in the US.

A colleague wrote in part : “This has been an ugly week of multiple clients upset with the executive orders. The thing that continues to strike me is how der Trumpenfuhrer embodies the sum of all fears…..I spent two hours on Zoom today with crying people in the midst of the total meltdown of their lives, having lost jobs in the past several months and now worried about the ways in which the executive orders will effect them and the world. It was an ugly day.”

My reply is below:

It seems very important for therapists to support one another in what they are observing and experiencing. Vicarious trauma may be on the rise in our profession when therapists witness and describe days like the one you just had.

Psychopaths like pain. Inflicting pain is the point because it makes them feel powerful. Perhaps one of the most challenging things for therapists to observe and attempt to mitigate is cruelty and sadism.

In recent days not only is cruelty and sadism being perpetrated but it is being normalized with "pardons" that lift external constraints and restrictions and allows those so inclined to behave in further cruel and sadistic ways with impunity.

As I learned working on inpatient psych units and psych ed what works best with these behaviors is injections of Haldol and four point restraint with a skilled team trained to exert a "show of force". These tactics are used only after de-escalation techniques have failed.

After such interventions staff always met for a brief de-debriefing so that calm could be restored and confidence in maintaining safe order was reinforced.

As therapists we need to find ways to keep each other safe so we can keep our clients safe as best we can.

Remember, cruelty is not a byproduct of what is being perpetrated, but the cruelty is the point to dominate, coerce, and subjugate. It is important for us as MH professionals to confront it head on, lean into it, and mitigate it. Some of us will be harmed in the process, but in the end justice, compassion, dignity, and peace will be achieved.

Keep the faith. Stay strong. Be courageous, Do the right thing. Focus on what matters.