Osama Bin Laden is dead.  9/11 lives on. The sudden annihilation of the man responsible for that cruel and ultimately defining act brought me joy,  and rekindled a sense of pride in our  country and its capabilities. 

Once I’d assimilated the news, blurred memories of the World Trade Center bombing came back into clear focus, like a blank sheet of photographic paper morphing into a crisp image. 

I was on the subway when the first plane hit.  Clueless, I got out and walked to my midtown office building.  Outside the lobby doors, I saw a group of well-dressed people talking on their cell phones. 

They say that our brains try to make sense of limited information by constructing the most likely scenario based upon past experience.  My brain said, “Ah, a group of tourists phoning home”.  Suddenly, a clean-cut young man in a business suit took off running.  He was heading south.  I thought little of it. 

A day or two passed. I sat in front of the T.V. with my wife.  Images of the planes hitting , the buildings collapsing.  Over  and over.  I felt shock, disbelief, anger and helplessness. I wanted to do something.   I needed a catharsis.  Being a psychiatrist, I thought that  perhaps  I could provide some comfort to persons affected by the tragedy.  I put my name on a few volunteer  lists, but didn’t get a call.  Angrier and more frustrated than ever, I searched for an alternative.  I found an ad posted by The Church of Scientology, seeking volunteers to work at a counseling center close to Ground Zero.  I attended a brief tutorial on crisis intervention techniques.  They gave me a white plastic hazard suit, a helmet,  and a mask. 

It was a Saturday, four days after the bombing. They bussed a number of us to atreatment center about a quarter-mile from what had been the WTC.  Nobody came for help.  I was so frustrated that I was ready to go home.  Then they asked for volunteers to go close to the site to hand out food and drinks to the men and women working there.  We were not allowed onto the site itself.  No “civilians” wanted, only construction workers at that point. 

After handing out nourishments, I did a little exploring.  I entered the World Financial Center, which was intact  except for a large metal beam that had struck and penetrated the brickwork. Inside, everything was covered with a fine white dust.  On the ground floor was a snack bar with plates of uneaten food sitting on the counters and tables.  I went upstairs.  There was a gym.  Rows of treadmills and exercise bikes, all completely white.  I thought of Pompeii, frozen in time.    

I had a goal in mind.  I wanted to get to the site itself, to the foot of that enormous, smoldering mountain of debris  surrounded by partially destroyed buildings and that iconic twisted steel lattice.  I snuck in when a police guard’s eyes were turned away and inserted myself into a  bucket brigade of masked and helmeted construction workers.  They were passing large pieces of debris, mostly twisted metal,  along a chain leading to a  collection area.  As I handled these objects to which I still felt no human connection,  I occasionally looked at the ground. 

Very few pieces of the debris lying there were larger than a foot in diameter.  Most were fragments  of electronic  equipment.  Smashed computers, monitors, wiring, keyboards, and small, unidentifiable objects,  some charred.  During a lull, I picked up a piece of paper.  It was a reservation list for the restaurant, Windows on the World, that had been at the top of the North tower.  Feeling guilty, I picked it up and put it in my pocket.

A piece of one of the jetliners passed through my hands.  I still felt so numb inside that, to me,  it was just another chunk of metal, not a fragment of a vessel that had carried so many innocent  people to their deaths. 

I dropped out of the line and started home.  As I walked along streets covered in dust and debris, I saw fire engines and cars flattened into amorphous lumps of  steel  a foot or two high.  One of the vehicles was a UPS delivery truck.   I noticed a construction worker staring at it.  I heard him say to a companion, “So that’s what happened to the package I sent!” They laughed, and so did I. That shared laugh was the first human connection I had made all day.  Black humor, yes.  But I felt a bit better.

Influenced by Freud, surrealist André Breton had coined the term “Black Humor” in 1939. He agreed with the premise that grim jokes help us overcome fear, and quoted Freud: “The grandeur in (black humor) clearly lies in the victorious assertion of the ego’s invulnerability… It insists that it cannot be affected by the traumas of the external world.”

I returned to the site the next morning.  The rules were even stricter.  No more construction workers. Police officers only.  I snuck in again and rejoined the bucket brigade. I saw disciplined teams of rescue workers  from all over the country making their way up the mountain,  stopping here and there to dig through the debris.  Cadaver dogs sniffing  away.  Every once in a while, human remains were  found  and shielded  from view by the workers before being brought out in black body bags.  

I saw a piece of flesh at my feet no more than two inches long.  I saw a priest blessing the bodies of three firefighters.  I looked into the face of the police officer next to me.  He looked back at me suspiciously.  He probably suspected that  I was not a cop.  Perhaps he felt that I didn’t belong there.  I couldn’t have cared less. I’d done nothing requiring any skill, nothing heroic, just moved some junk along, but felt more at peace.  I’d started to heal.  The mountain kept on burning.

You might imagine that Charlie Sheen, given the number of people who have commented upon his recent activities, has a fairly lengthy shit list. But, so far, he’s only publicly challenged one person to a punch-up: Dr. Drew, AKA Drew Pinsky, M.D., addictionologist to the stars. Said Charlie: “I think me and Pinsky should jump in the ring and he can see how unstable these fists of flaming fury really are. I’ll show you how unstable I am. Bring it! Bring it little man!”

So what’s Charlie’s beef? He has taken issue with Dr. Drew’s armchair diagnosis, made on Hollywoodlife.com, that he was in a manic state, and should be hospitalized on an emergency basis.

Dr. Pinsky is not the first physician to draw broad conclusions about a public figure from few established facts. Years ago, psychoanalyst Dr. James Brussel, author of the book, “Instant Shrink: How to Become an Expert Psychiatrist in Ten Easy Lessons” (take note, Dr. Drew), was asked to profile the notorious “Mad Bomber” who terrorized New York City in the Forties and Fifties. 

Dr. Brussel quickly painted a detailed portrait of the Bomber, George Metesky, that included a strong likelihood that he favored double-breasted suits. When apprehended at home, Metesky was wearing pajamas, but, (Aha!) changed into a double-breasted suit for his trip downtown. Dr. Brussel was praised to the heavens.

In a 2007 New Yorker piece on criminal profiling, Malcolm Gladwell wrote: “If you make a great number of predictions, the ones that were wrong will soon be forgotten, and the ones that turn out to be true will make you famous… It’s a party trick”. 

My point? Today’s armchair diagnosticians, enabled and empowered by a celebrity-obsessed culture, are, like Dr. Brussel and Dr. Pinsky, performing party tricks. Why not impress and entertain a credulous public with fancy medicalese and psychobabble, while getting to bask in the reflected glow of their celebrity targets?  

As a psychiatrist, I am most familiar with the American Psychiatric Association’s  position on diagnosis at a distance, although other professional organizations take a similar stance. “It is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.” 

Diagnostic labels, particularly in the highly sensitive fields of mental health and chemical dependency, are scarlet letters that stick, and they should not be recklessly applied to public figures by mediagenic, attention-seeking, gossipy types who end up perpetuating negative stereotypes of their chosen professions while serving little constructive purpose.

Tracey Jackson needs to lighten up (“Hey Baby Boomers, Grow Up!” PostScript, Feb. 27).

As a so-called Baby Boomer, I take issue with her opinion. Jackson appears rigid and conventional in her thinking, expressing views that seem out of touch with the times.

Older people are being increasingly spared the invisibility, prejudice and stereotypes that have prevailed for years in our youth-oriented culture. Plus, many are forced to continue working years beyond retirement age and are living much longer.

People should be permitted to wear whatever they wish, whatever their age, even if it’s a Marilyn Manson T-shirt or plumber’s butt pants. I can’t help but imagine that, at 65, Jackson would prefer seeing me in dress trousers belted at the chest and white shoes with big gold buckles.

The admonition to “grow old gracefully” is ageist and nonsensical. One of the blessings of getting older is not caring so much about what others think of you and being free to express yourself, verbally or otherwise.

Here’s the link to the article in question:
http://www.nypost.com/p/news/opinion/opedcolumnists/hey_baby_boomers_grow_up_VGP1IaaYxVukUacpQuoLvO

Check it out on the Shrink Rap blog site at
http://psychiatrist-blog.blogspot.com/2010/11/guest-blogger-dr-darell-on-not-being.html

It seems to me that this kind of criticism of the insurance industry misses the more important point. As a psychiatrist, I am not enamored of piles of paperwork, debating with peer reviewers, and feeling that my patients are sometimes denied important services on the basis of cost. But, many physician complaints about the system seem, to me, narrow in scope, if not downright self-serving.

I was practicing in California when managed care arrived in the mid 80′s. I hated those calls from insurance companies that made me feel that my competence and judgment were being questioned. Then again, some of my colleagues were keeping patients in the hospital until their insurance ran out, declaring them cured, and discharging them. And there’s the psychiatrist I knew who was billing for psychotherapy with a patient in an ICU who was in a coma. I accept the few bad apples theory, but physician greed certainly contributed to the backlash that occurred.

At the present time, over 16% of our population has no health insurance, yet we’re spending an almost identical proportion of our gross domestic product on health care, and bankrupting our system. All the complaining in the world won’t change the fact that something’s got to give. We can blame overpaid CEO’s, an excess of mid-level managers at the companies we revile, lawyers and politicians, but let’s look at ourselves. All too often, we think of our patients, our income, all the rewards we were promised for staying up all night studying or working 72 hour shifts as house officers, piling up debt while our friends were working for a decent wage and having fun.

We’re not entitled to anything. Nobody is. Let’s accept current realities or work to change them instead of holding pity parties for ourselves.

Link to original blog: 
http://www.psychiatrictimes.com/blog/couchincrisis/content/article/10168/1707756

If you wish, you may view my professional profile at
http://therapists.psychologytoday.com/rms/prof_detail.php?profid=83927&sid=1288878523.9901_12084&lastname=Darell

http://directory.psychlinks.ca/General-Mental-Health/

Useful resource for information on mental health and related issues.

Long-term, severe sleep deprivation can result in severe illness, hallucinations and death.  That doesn’t mean that short-term lack of sleep has no adverse consequences.  Recent studies have found that even  several  days of  reduced or shallow sleep can accumulate and resemble the effects of several dozen hours of acute sleep deprivation. 

Sleep deprivation increases the risk of obesity, diabetes, and cardiovascular disease, which are among the medical conditions that we try to prevent via regular exercise.  Thus, even looking at the short-term, sleep deprivation has significant adverse effects that almost certainly outweigh the benefits of exercise.

The sleep versus exercise question has no black and white answer, since exercise is often beneficial to sleep.  Recent findings suggest that, contrary to popular belief, exercising vigorously close to bedtime does not cause insomnia. So my overall feeling is that, given a choice between sleep and exercise, sleep should be given priority.