Bye Bye


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This is a hodge podge of commentary per things that have really pissed me off, but let’s start first with the last time I will read at the  How to present this latest disrespect to me?  Well, first the post I read last week:

Then, my first comment I wrote, that was printed:

5/3/2018 at 9:53 pm


Sorry, I disagree, as a mental healthcare professional it is not healthy for a parent to frame a child as a best friend.Children are a dynamic that is different than friendship, so I hope the author of this post rethinks this and considers how this can cause a lot more harm than benefit.Joel Hassman MD,Board certified psychiatrist


And then the author wrote this as an alleged rebuttal:

5/6/2018 at 5:46 pm


Apparently neither one of you have had the pleasure of raising a teenage daughter. Nor are you authorized to slander or tarnish my personal experience. You have made my first published blog a very negative experience. This is my blog and you are welcome to move on and not read it.
Thank you both for your professional and intelligent feedback. 

Now, things have gotten a bit murky, I wrote this Monday night, and it was printed on Tuesday AM,

5/7/2018 at 4:39 pm


Dr/Ms Amster:While I appreciate you did allow my comment in the thread, I have to say per your last comment from 5/6/18 PM to be a bit unprofessional. Yes, you are right, I did not have the pleasure of raising one teenage daughter, but, two of them, and I love my children tremendously to a point I would gladly lay down my life to save theirs. But, I do not see either of them as a “best friend”, and I noted your column to my wife who agreed with me she does not frame her relationship with them as a “best friend” dynamic.I have been practicing psychiatry for over 25 years, and in my travels, perhaps a skewed assessment per what patients have brought into the office and not just interviewing anyone off the street, I would say with 90% accuracy the women who have identified their daughter or mother as their best friend have had interpersonal issues that played a role in their seeking mental health care services. I stand by what I wrote last week: children are NOT our friends, but, our family members, and that is a dynamic that I view transcending friendship.You certainly are entitled to your opinion and perspectives, but, so am I. If your viewpoints and frameworks sustain you personally and professionally, congratulations. I believe you are the 10% exception to this perspective about a child is a best friend, and I hope you will consider this opinion, not agree with it, but certainly not frame it as a negative experience and make assumptions without reaching out to a commenter first privately as we give an email address to get a comment published.

I wish you well in your endeavors as a professional and blog writer. Be prepared for criticism, dissent, and sometimes frank trolling that is beyond harsh and inappropriate. But, you moderate, and do it wisely and responsibly. You are completely correct, we can move on and not read your opinions. But, maybe sometimes others will be empowered and impressed, while some will just shrug and say, whatever.

Been writing for over 5 years, and frankly, those who hate me seem to want to note it over and over if given the chance. Hence the beauty of moderation…

Again, thank you for the respect to print my earlier comment at least.


Joel Hassman, MD


but then last night there were an alleged two more comments that would not appear, but then I get this personal email from John Grohol this afternoon who, well, I will print it and risk his wrath as a betrayal of alleged confidentiality?:

Hi Joel,

Thanks for your comments on the “Giving birth to your best friend” article on Psych Central’s World of Psychology blog.
As you know, we abide by and ask that our commenters abide by a set of blog moderation guidelines for discussions. That means you should refer not to an author or their experience or credentials, but to the topic at hand. It’s not enough to just say, “Well based upon my 25 years of experience, I disagree.” You’re entitled to your opinion, but not to publish said opinion if it attempts to tarnish another person by calling them “unprofessional,” appealing to authority as an argument, or by suggesting that they are making it their own “negative experience.” 
We do not share email addresses with other commenters, nor does a blog author have access to a person’s email address who comments on their blog.
We’re a wide-ranging platform that is tolerant of all views, no matter how much we may disagree with them. We hope you understand the line between ad hominem attacks against a contributor, and thoughtful discussion about a given topic. Usually you are pretty good with this, but this time around, I’m sorry to say we had to remove these comments as violating our blog moderation guidelines.
Please let me know if I can be of any further assistance, and I thank you in advance for your cooperation in this matter.

And then, I go to the site to see what he did about her comment or if he added an addendum to the discussion, but, lo and behold my second comment was GONE.  Well, until I have started this post, and it is now magically back, along with others since added.

Here’s a link to the thread for all to read and digest:

Even after seeing the comment has been restored, my faith of has been tarnished, and I am still going on record as saying my travels there are done.  I will say to readers who might read there, read and comment at your own peril, but, realize there are snowflakes to be nurtured there, and while Dr Grohol might take some umbrage to the way I frame this here, well, sorry, that is the message I take as of now.


Anyway, moving on to bigger and more obnoxious matters, on Saturday I get this letter from the State of Maryland that I have to take time and my money to be fingerprinted to prove to the State I am not a danger to patients and colleagues.  Having read up on the matter this afternoon at lunch, I do get a bit of the reasoning behind it, but, to pay for it, nah, forget the State of Maryland, I pay $520 every two years for keeping my license to practice, and the State runs this fingerprinting process, so they can eat $40-50 bucks for doctors to show they are legit, until proven otherwise.

God, it’s bad enough I am treated like shit at the assignments I work these past few years overall (some facilities have been nice, but the last two, never will work there again, count on those words here!).  Now I am a criminal until proven otherwise.


Finally, while I have commented on this over and over, including my last post, the Axis 2 shit that is so pervasive across the land, forget politics for a moment, is just so overwhelming to handle these days.  Selfishness, entitlement, and sheer arrogance and pettiness, well, I do have a drug for this, it’s called syrup of Ipecac, and people need to spew that garbage up and out.  What is this?

Thank God I only work 3 days a week of late, I am so burnt out Wednesday afternoons, I really appreciate the couple of years I accumulated 6000 plus songs on my original Ipod so I can listen to assorted playlists on my two hour drive home.  Music is the main source of rejuvenation for me, I recommend it highly to those who are dealing with burn out, pervasive aggravation, or sheer hostility in dealing with the masses these days!

I leave readers with a song that is rude, but, a catchy tune:

Sorry, I like the song, and it completes my evening, have a nice Mother’s day coming up, and not the Mother that Sam Jackson shouts with glee…

Addendum 30 minutes later:

I just wrote this comment, doubt it will be printed, but, for me to remember for prosperity and to note I try to end on a positive note as best possible.  Yeah, I know some will tell me, “not so positive there Joel”…

“As my last comment to be submitted to per the way this thread has been managed by both Dr Amster and Dr Grohol, I just want to go on record noting the inconsistencies that have gone on here:

Firs, to rebut the most recent comment by Staci Schnell, um, I hope you read the title and the first paragraph I will copy below:

“My mother always told me, “When you have a daughter you are giving birth to your best friend.” As I grew older and had a daughter of my own, that statement began to really ring true for me.”

That seems to reflect some missing information I feel Ms Schnell is overlooking that was quickly gleaned by me in my original read;

Next, I am baffled that I am being called out as being “authorized to slander or tarnish my personal experience” by the blog author here. Um, this is a call out to Dr Grohol specifically, where am I slandering the author’s experience!? He knows why I am bringing him into this thread, and frankly, I think he owes it not only to me, but to readers of this thread in the future, having blog authors agree to a thread and then publicly insult commenters is really poor form! ;

Finally, I want to note to readers of blogs, the authors and the editors ask us for our email addresses, and the point to this, as I have a blog as well, is to decide not only if to print a comment, but, to consider contacting the commenter personally as the comments are being moderated. Thus, if someone is really being a troll, outlandishly rude, or misinterpreting the point of a column (as that is being contested here by both author and other readers), it allows for private clarification and then move on to submitting the comment for discussion and consideration.

I have been a reader here for many years, and while I have at times been a bit outspoken and considered being a violator of the Psychcentral thread policies, I know in my heart I have never been intentionally disrespectful, harshly rude, or inconsiderate. But, after this column and comments and reaction by the site editor, I note I am moving on to other sites for information, perspectives, and discussion. I am genuinely sorry if I insulted Dr Amster with my original comment, it was intended as an observation and perspective, but, I will not recant it. Nor will I change my second comment in any form as well.

I think the “snowflake” phenomenon that is going on throughout America has seem to landed here as well, and I will not mince words in saying that if people can’t handle criticism, dissent, or outright disagreement, then, don’t write or work in mental health care! We are trying to help and educate people be more healthy and functional, and some will appreciate it, some will not understand it, and unfortunately, some will overtly be outraged and activated to rebel.

Hey, this is just my opinion, but one of 25 years in the trenches of mental health care as a psychiatrist, the past 5 plus years as a blog writer, and, over 50 years of being an American citizen.

Here’s my closing tip, again for anyone interested: I think personality disorder is running rampant in America, and if we don’t as professionals, as citizens, as family members, and as invested humans in general, try to regain a healthy and functional herd of our species, well, letting rigid and inflexible behaviors go unchallenged, good luck.

Thank you again for the opportunity to comment, be safe and well, and most of all, be true to who you are in your travels across the lands.


Joel Hassman, MD”

Flame on there Johnny Storm…




The Personality Disordered Mayhem is not only pervasive, but endemic…

How can any healthy, responsible person watch this shit show of American politics much longer?  The narcissism, the antisocial charades, the absolute histrionics of the Left, and the sheer near schizoid reactivity of the Right, wow, this is beyond a documentary for the public to watch daily, eh?

But, we have the avoidance and dependence of the average citizen to add to the pathos, and, god knows I see this daily in my outpatient pursuits.  I find it nothing less than amazing how many colleagues just give rote diagnoses for behaviors that at least are equally based on Axis 2 crap, and yet, can’t justify any meds for that diagnostic criteria, so, anchors away for Mood, ADD, and PTSD diagnoses, eh???

Burn out is a misnomer, I am just waiting for spontaneous combustion.  I’ll leave readers with this wonderful moment yesterday:  my last patient was a 20 some year old male, who was recently hospitalized about 3 months earlier for a psychotic break that was confounded by substance abuse as well as pervasive non compliance with past psych interventions, and I was seeing him for the first time.  He actually came earlier, and I was done earlier as well, so brought him in about 5 minutes before he was to begin.  He had little if anything to say, had no collateral or accompanying staff or other information to review, so, we spoke for about 10 minutes, and then he left.

Ah, but, two different therapists who are involved with his care show up at my door about 5 minutes later asking what is going on with the patient, as someone called earlier in the day to report he was drinking alcohol this past weekend.  OK, so, the contact reporting this allegation was at least a hour or more earlier, I leave my door open when not seeing patients, and do review my emails with some regularity during the day, and nothing about this prior to the patient visit.

So, when I tell the staff I saw the patient and he left, what did one of them do?  Act disgusted and rip up the note in front of me and the secretary who brought them to my door, and then stomped away.  This is the absolute shit garbage I deal with per these “therapists” who really just want people drugged and uneventful for therapy visits.

I’m working three days a week right now, and frankly, more than enough.  The usual assembly line crap at these clinics, see them in 15-20 min slots, write meds like Pez, accept that patients see therapists every 3-6 weeks when in alleged crisis, and then be badgered WHEN the patients are symptomatic because meds don’t treat the life issues.

Cue Frank Barone, where is the god damn meteor to put me out of my misery?

Here are some moments to appreciate the character:

Socialism: code for real antisocialism!


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This is one of those posts that will be a work in progress the next few days, as I just got home for the week, yep, on Wednesday as I will not burn out further by working 4 or 5 days and just write endless scripts for drugs and listen to repetitive Axis 2 crap to why patients should be given whatever they want.  Frankly, I don’t know how caring and committed psychiatrists who provide community mental health care can go to work and not risk spontaneous combustion.

Anyway, the thrust of this post is about Alfie Evans from Liverpool, England.  For anyone who has no clue who this 2 year old is, I hope this link gives a decent synopsis up to today, April 25 2018:

I wrote about a similar case last year, here are my two main posts about Charlie Bard and how the English shit holes of socialized medicine killed this child:


Hope readers will take the time to read, and then compare to what is being done to this recent child.  Socialized medicine is not about providing equal and just care to everyone in society.  Nope, it is about limiting care, using it to be controlling and punitive, and to basically decide who lives, who dies, and how the shit heads who run it would never have to answer to such limits and boundaries they set for the public.

Hence, the set up for the antisocial to thrive…

Leave with this:  the hospital and court is not only telling the parents they can’t have their child, they actually have police at the hospital to arrest them or anyone else who would dare to try to help this child have a chance at life.

If that isn’t f—–g murder, then you define it!

More to come by Friday…


Addendum April 26 12N:  Few links that should be of interest:

“Who do you think loves that baby the most?” Levin continued. “Who do you think wants to care for that baby the most? Judges? The doctors? No, the parents.”

Levin concluded that this is exactly the kind of thing that happens when people give the government control over their health care, and by extension, their liberty and their lives: “In the end, it’s a disaster.”

then from Townhall chief editor Guy Benson:

I’m not even sure that’s much of an exaggeration.  Throughout this ordeal, I’ve struggled to grasp why a government would be so hard-hearted and so hostile to the wishes of a despairing family.  Allahpundit offers a chilling theory that I fear is more or less correct: “The only conceivable reason the UK would refuse to let him go is because they’re terrified that he really might be successfully treated. If they’re wrong on a question of life and death that’s now being scrutinized internationally, no one would ever trust an NHS end-of-life assessment again. Letting him go would require the British health-care and judicial systems to do the one thing bureaucracies bristle at doing, knowing how it undermines their institutional authority: They’d have to admit they were wrong. They can’t do it.”  Sickening.  Incidentally, if this were a government minister’s child, or one of the celebrated Royal Babies, does a single person alive doubt that every single effort would be exhausted on behalf of those families?  Oh well.  Sorry, ordinary people, the government controls how and where your child must die.  You have no say in the matter, and you must comply.

Sums it up perfectly for me, why socialism and these faux efforts to give the illusion that everyone is equal is such complete and utter bullshit.

More to come, but, first nice day this week in Maryland, so outdoors I go…


Addendum April 27 7AM:

Two more links, the first with this:

“Why the reversal? The key is his announcement that he wouldn’t make additional public statements or give further interviews. Someone in that meeting allowed Tom Evans to glimpse the true power of the state, explained how he was causing it inconvenience, and made him understand that it would crush him if he didn’t relent. This is perfectly consistent with everything the NHS has done since the beginning of this tragic, yet instructive tale. From the moment the apparatchiks at Alder Hey Children’s Hospital advised him that it was no longer in “Alfie’s interests” to keep him alive, Evans’ ability to affect that decision was illusory.”

There is much more in there, read it.  Then from my favorite of late, Mr French:

He hits it out of the park with this:

“If you don’t want America to become Britain — if you don’t want to wake up one morning to find the American state defying loving and prudent parents to declare that death is in a child’s “best interests” — I would suggest that you not wait until America is secularized, centralized, and authoritarian. I’d suggest that you not wait until the moment when the state has seized the power to act like Britain, and you’re reduced to arguing, “I know the government can do this, but it shouldn’t.”

How stunningly insincere and downright disingenuous of the ruling class, and their ignorant classless peons of subjects, that they all worry about what will be the name of the latest brat to be Prince just born, yet don’t seem to care about a child who will be dumped in the trash heap of yet more subjects seen as dispensable.

Oh why can’t we see a “John Q” moment across the polluted pond…

oh, and add this read too just 5 min later:

“Alder Hey’s physicians have been unrelenting in their abandonment of this child, having decided more than a year ago, in February of 2017, that Alfie should quit embarrassing them by surviving in spite of receiving no treatment and get on with the business of the afterlife.

Since making that decision, the hospital has refused to perform even the most common of procedures for a patient with Alfie’s needs, such as a tracheostomy to facilitate easier breathing or a gastrostomy feeding tube for nutrition and medication.

For all this time, Alfie has been fed through a nasal tube, never intended as a permanent solution, but rather as a stopgap (weeks, not months) designed to be used until a g-tube can be placed.

The medical treatment Alfie has received is abominable, as a direct result of the hospital’s decision, and subsequent criminal obstinacy toward anyone suggesting that their prognosis might be in error.”

And this from a writer who claims having a grandson who would have had the same fate if he was living in England.  Thank God NOT!…


Last addendum here, hopefully, for this post, April 29 10AM:

Two more links, one from a writer I enjoy, that being Derek Hunter, shame he was forced off the radio here in Maryland:

“If Alfie were to have lived it would’ve not only expose the “experts” as being wrong, it would caused people to question the wisdom and compassion of a system they’ve been conditioned to believe is the best the world has to offer. It would’ve lead to questions, like why their government was willing to kill this baby rather than let his parents try anything possible to save him.

Then those questions about Alfie might’ve be asked about other people’s loved ones. Expectations could rise, and who knows where that could lead?”

then the second from a couple of days ago:

Mr Wheatley ends with this:  “What, then, is the difference between little Alfie’s case and the case of the poor American who cannot afford the health care he needs? Simple: The American’s life was lost. Alfie’s life was stolen.”

Again, readers, when people think the system is going to be fair and consistent with all, that is the big red flag that not only will it not, but, it will go out of its way to punish and control.  Humans have not developed into a species that works as a team, but, has devolved into allowing this alleged alpha to be just the ultimate predator, with no concern how the behaviors and outcomes will play out.

What is that line from “John Wick 2”, by the manager of the Hotel says to Wick when Wick does not honor the blood code:  “Rules, we have to live by the rules, or just live with the animals.”  Ironic the animals define us…

A Tale of Two Babies

Good luck folks, the Democrats who are the animals, are setting the rules, and their rules really aren’t much better than the codes of the wild, eh?!

Add on at 3PM:  per this link

“For five days, 23-month-old Alfie Evans clung to life at Alder Hey Children’s Hospital.

When Alfie’s doctors gave up on him, his parents wanted to take the boy to Italy to treat his degenerative neurological condition. Barring that, they want to take him home to die.

The hospital refused, and in Great Britain, Big Brother knows what’s best for every patient. The hospital took Alfie off life support last Monday. He died early Saturday morning.

When we put the state in charge of the medical care we receive, we cede control over our own lives. Even well-meaning bureaucrats can’t place the same value on a young boy’s life as his parents. Yet they are trusted to determine that child’s best interests. We become not citizens, but subjects.

This is inevitable, once we surrender responsibility. Socializing our health care would inevitably lead to state officials rationing care. It would be irresponsible of them not to use their best judgment on how to allocate scarce public resources.

America’s Founders rebelled from Great Britain so that Americans could control their own destiny. We can think of fewer liberties more essential than the ability to care for a sick child.

Perhaps Alfie Evans’ parents wanted to make the wrong decision, clinging to false hope for a child beyond the reach of modern medicine. But it is their decision to make, not a doctor’s, or a hospital’s, or a national health service’s.

In Great Britain, the state routinely decides which innocent lives have value.

May the United States never reach that point.”

Couldn’t have said it better…

May 2 2018:  have to add this last link:

“This is, quite simply, tyrannical. It is one thing for a judge to decide that British taxpayers should not have to bear the cost of what doctors in its national health service have concluded is futile treatment. Under a single-payer system, resources are limited and care is rationed (which is why we don’t want socialized medicine here in America). But where does a British court get the right to deny the child life-extending treatment abroad when someone else is willing to pay for it? Who gave the British state the right to determine what kind of life is worth living and for how long?

Diabolically, High Court Justice Anthony Hayden actually cited the pope in justifying his decision to end Alfie’s life, quoting out-of-context a speech Francis gave in which he warned against “the temptation to insist on treatments that have powerful effects on the body, yet at times do not serve the integral good of the person.” But Francis also declared in that speech that decisions about whether to continue treatment “should be made by the patient.” Nowhere did he say such decisions should be made by the state. And indeed, the pontiff made clear he stood with Alfie’s parents, tweeting, “I renew my appeal that the suffering of his parents may be heard and that their desire to seek new forms of treatment may be granted.” For the British High Court to twist the pope’s words to justify killing a little boy is monstrous.”

This is how evil proliferates, how it denies, deflects, projects, and pathologically rationalizes that their narratives trump anyone else.  F—–g sick!

And there will be another incident coming within the next 9 mos or so!


Isn’t all this characterological pathology running rampant fun to watch?

Wow, the last few weeks have been quite the Axis 2 shit show, eh?  And it isn’t just politics, but what we see, read, and hear across the country locally and in fairly much all the states.  I’m not going to even try to spend time with examples, but, I just want to remind any and all readers, much of what is going on that is just outrageous, ridiculous, inferior, and plain disgusting, is driven by personality disordered losers.

These losers are people who can’t effectively problem solve, who can’t negotiate, who think their way is the only way, who have such a profoundly consumed hate for their enemies and dissenters, and genuinely think the people not only around them, but anyone who even remotely learns of these losers’ alleged plights and problems will be forever supportive and invested.

God, I see these people every day at the clinics I work at, and it is simply astonishing how these people completely live a narrative and agenda to do what they want and seek, irregardless of how it impacts on their immediate family, neighbors, and fellow citizens.

I wish it was just addicts, but, aren’t addicts at least personality disordered impaired because of their entrenched dependency?

We are beyond doomed, folks, we are f—-d beyond hope.  The logarithmic growth of this self centered and rigid, inflexible patterns of thinking and problem solving will destroy this country, if not instead pervasively, extensively, and consistently repelled as it comes along.

Hey, don’t believe me, just listen to the people of power and influence.   NOT!!!…

America burns

How do healthy people watch the news these days?  I don’t…

The perfect psychiatry job…


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is, well, while nothing is really perfect, one can hope and dream, eh?!

I find it so dishonest and disingenuous of the APA newsletter to be putting out all these articles in the past few months about how to identify and lessen burnout.  This organization has to be one of the biggest shit bags on earth!  They want to lecture us on how to give hope and faith to providers when the APA shits on those who do not suck on the fat ass of what the APA really reveals.  They just want to be relevant, and make money, and then give the most pathetic display of faux compassion and disdaining caring for the public…

Well, Bullshit to the APA, bullshit to the allied professions in general that work in mental health, and bullshit to the patients who think they either get the best care someone else’s money can buy, or worse, these patients think they can better without having to exert any real time and effort.  Oh, and forget noting Bullshit to the insurers and the politicians who have the most control over the treatment process.  Those assholes sold their souls decades ago, and if they had a single moment of candor to what they would genuinely say to the public about letting people access the true and needed care interventions to have a chance at better mental health, they would just get in the patients’ faces and say “forget you and die!”

But, the point of this post is simply this:  what would be the best qualities, the most desired characteristics of a position that would allow a psychiatrist to flourish, to be invigorated, to be full of passion and caring?

I’ll list as a start what I would want, and that would be in outpatient services:

* screen out almost all the primary substance abusers and major dementia patients.  We can’t help these people, because psychiatry was never set up to work with people who have such little hope and motivation for change as a pervasive majority of these two groups.   Sorry, that is an honest appraisal.

* patients who come to a mental health clinic HAVE to see a therapist if they are not able to see the psychiatrist for some structured therapy interaction.  How often and sustained this expectation has to go is open for negotiation, but, therapy has to be part of the process in over 95% of the patients who come for services.

*most of the paperwork demands asked for psychiatrists should be handled first by ancillary staff, not that such aides can complete it all, but, get through the tedious and repetitive bullshit that most of these organizations involved with the patients just dump on doctors to complete.  And, we the physicians have the right and ability to say “no” to fill out wasteful and sheer bureaucratic bullshit requests.

*patients who miss appointments either calling in last minute or not showing up at all will not be given much if any priority to be seen unless they can clarify or quantify why they did not attend, and for those on medications, will only get enough supply until the next appointment they make AND then attend.  Yes, there are exceptions, but, again less than 5% of the time.

* most collateral paperwork that is needed to help with the assessment and ongoing care needs should be equally obtained by the patients as much as the clinic staff.  In this day and age, patients seem to have more clout to at least set up the transmission of information, and they should accept such responsibility.

*Lab studies needed by psychiatrists should be ordered by such physicians.  We do not have to run by PCPs our lab needs, and when we are the prescribing doctors for lab needs expected for meds like Lithium or Depakote, or antipsychotic meds like Zyprexa or Seroquel, then we have to have those results in a timely manner.

*court cases are not referrals to any provider but to those with a genuine expertise or a willing interest to work with such patients.  As long as the courts present care as a punitive issue, I for one want NOTHING to do with this scenario.  Let the Legal system set up treatment facilities who can fully and effectively treat and communicate with the legal system that is trying to control the patient.

*patients who are legitimately on controlled substances HAVE to be seeing a therapist ongoing until either the therapist genuinely says the patient has completed the therapy process, or the patient goes off the prescription(s).  No exceptions, even with patients on ADD meds, I don’t care if they see a therapist every 3 months, it demands the accountability and responsibility such medications require.

*Also, patients on certain psychotropic medications HAVE to be followed by a PCP, again in an ongoing manner, as psychiatrists more often than not are not fully able to manage medical needs that will be minimized or just ignored until proven otherwise.

*while this next one is not an absolute, MOST patients over the age of 55 years old should not be on controlled substances, at least until less invasive and less complicated meds and other interventions are fully exhausted first.

*This one is probably a bit trite, but, I fully believe that patients who are brought in by support organizations like developmental programs, or residential ones, HAVE to bring patients on time consistently or risk being turned away to access the clinic.  And, these programs have to be fully prepared with ancillary and collateral information at the time the patient arrives, not have any illusion such information will be dumped, er, dropped off later to be completed or reviewed.

*these last two are pet peeves of mine, but, I think some might identify with them:

children under the age of 10 should not be allowed to be in attendance with their         parents unless the circumstances are so incredibly exceptional, and, the doctor has the     right to end the visit without the patient approval if the child is outwardly disruptive.

in community mental health clinics, blocks of time should be carved out to see chronic     patients so there won’t be a risk of chaos and disruption, as well as scattered no show   periods such patients are at risk to present.  That is NOT a segregated or discriminatory   request/expectation, but a way to maximize care and staff support.


Well, that’s a start, I will likely come back in a couple of days and add some more expectations and clarifications, but for now, read and digest.  Any and all input is genuinely appreciated and requested, but give some clear reasons why what I offer above is not a realistic or fair agenda as a provider.

Oh, and when is Spring coming to the East side of this country?!?!


addendum April 25 7PM:  Sorry to anyone who has been coming back to see if I added anything to this post for more reasons to find the perfect position in psychiatry, but, I had to endure more headaches to learn:

* Insist on weekly staff meetings to discuss clinical care issues, review cases, and to interact with staff outside barren hallways.  Administration thinks this is wasted time, and that shows why administration is wasted salary for care issues in the first place.  Coordinating and maintaining continuity of care makes for better clinicians.  Oh, maybe why administrative officials are so against the process?  God forbid we can improve peoples’ lives to a point they might not have to keep coming frequently, if in fact they can conclude they are better enough to stop coming!?!?

*Realistic breaks, as a start, one hour lunch breaks.  Come on, who really has the time to take a full half hour for a meal without prior patient care issues intruding into the beginning of the lunch break, much less being able to eat in peace for a half hour?  How many people watch non clinical staff get to go out every 2 hours for a 10 minute smoke break?  At my last assignment, I saw it, and frankly, it is obscene it is allowed for two reasons:  that is thirty minutes of paid time to smoke and take away time from one’s lifespan, and second, smoking is counter-productive to the message we are trying to send to patients to improve their lives.

*Close cases with authority, and stop letting administration use lame and pathetic excuses to NOT close a case simply because of PR.  Think about this for one moment, the people who are flirting with their care being ended are not compliant, concerned, consistent, nor committed people to expend time money and energy to continue offering services.  But, I have no flippin’ clue why so many administrative people are so hell bent to not let a patient be discharged.  Because I have plenty of CLINICAL reasons that aren’t obligated to concern about numbers and billable hours.  Sheesh!

*Document consistently and outwardly the endless insurance intrusions and efforts to direct care away from actually helping people improve.  I think it is only a matter of time a real interested, invested attorney or law group can figure out a way to show there is liability the way insurers are screwing the patients.  And once an insurer is successfully sued, for a shit load of money, I think there will be real fear to what these scumbags think they can continue to do to people.  Hey, At least it can protect providers to some level depending on what the clinicians are doing when these pathetic and ridiculous authorizations and denials are thrown at us!

*Finally, as alluded to above per break time, I think it is time for honest, concerned, and committed clinicians who do not smoke tobacco to show some real gonadal fortitude and be responsibly intolerant of tobacco use, PERIOD!  Frankly, I think working with patients who at least 80% smoke with regularity shows a level of hypocrisy and inconsistency that dampens our expertise, responsibility to the public welfare, and sells short the message we are allegedly selling in healthy choices and outcomes.  Smoking stinks, smoking sucks, and smoking diminishes a chance to improve physically and mentally.  Gee, now that is a revelation!

Well, that is likely the only addendum to this post, so I hope those who have been interested to what I offer to make psychiatric care for outpatient services at least have some chance to be actually enjoyed and appreciated!  People want to stop burn out, well, think about what you want at your job to actually wake up and want to go to work and make a real difference.  Not. Happening. Here. These.  Days!!!

What is tolerance?


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I read the most recent column by David French at http://www.national, and boy, it was an eye opener.  His point is well taken by me, read it, but the end below is beyond succinct:

“Exercise those rights [to free speech and freedom of association] , but progressives be honest about your purpose. You can call  it tribalism. You can call it social justice. Just, please, do not lie and call it tolerance.”

At least I get the terminology correctly now, so we have to decide, when are we tolerant of people and behaviors that could be viewed as intolerable by others, and then, when can we be inclusive to let others we would be hesitant and wary to allow into our circles?

And step back and listen to the lies, misdirections, and frank intolerance and brutal efforts to ostracize by the Left and their ilk.

Oh, don’t get me wrong, the Right and Republicans aren’t so tolerant and inclusive either, they just still play the game of the mensch in being dismissive…

Image result for picture of David French from National review

MR FRENCH, no relation to the original Mr French those over 50 know so well and appreciate what the character went through on Family Affair…

Related image

Enjoy, have a nice weekend and for those on the East Coast, WHEN THE HELL IS SPRING GOING TO FINALLY APPEAR ENVIRONMENTALLY ?!?!

How to neutralize David Hogg and his miscreants…


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First, the basics to how this post can possibly help those who want to see this immature and unqualified jerk be silenced.  This is NOT about winning, it is not about beating him, and it is not about his benefactors being silenced in any significant form.  No, evil cannot be destroyed nor completely beaten, but just as I wrote above, neutralized.

Unfortunately, sorry to readers who want this to be civil and dignified, nope, not an option when you are dealing with near or full adults in age alone.  People have to remember the opponents are personality disordered creatures who will not be appropriately negotiated, nor realistically reasoned with to some moderation, and certainly their goal is not just about winning, but fully crushing any seen as an opponent, who dissents at all, who wants any form of middle ground.

Finally, the audience the true adults want to rally as allies and supports, well, the allegedly neutral audience will outwardly want people to be polite and respectful, but, the audience is not actively engaged in this battle, and they want someone else to fight.  SO, the rules are not set by the audience, and if they are impatient, if they are cowards, if they are looking for what is popular easy and convenient, well, not the target audience in the end, eh?

People like me are both participants and audience, as I have no direct stake in this battle per a political affiliation, as I am a pure independent, disliking Republicans for decades, and now realizing the last 10 or more years outwardly hating the Democrats for their growing antisocial agendas and narratives.  Frankly, both parties could die off in the next few years and I won’t miss either at all.  But, I won’t be silent watching this shit show being shoved down our ears and throats by the Democrat ilk.  So, here are my tips to hopefully enlighten and empower those who want this punk shit kid to be exposed as the fraud, and more so the current front-kid for these entrenched scumbags of the Left.

First, those who want to take on Hogg, well, how do adults deal with 5 year olds who are just pervasively acting out in public?  And that is what this guy is, a 5 year old in a 17 year old body, but, his behaviors and rhetoric are what you hear from a 5 year old.  Mature adults do not dis apologies, do not say “fuck” in every other sentence on a family rated cable source, and certainly do not insult and demean adults who are not known.

And mature adults do not cry “foul” at the slightest criticism of a comment or narrative, and do not claim a right to regress to claims of being a victim or part of a special group who deserves different rules when responsibly attacked in dialogue, and, mature adults do not say almost word for word, “well I know what you are but what am I!?”

No, that is what 5 year olds do, and think about it for a minute before reading further…

So, how do you deal with a 5 year old being disruptive and demeaning?  First, find the parents, if they are around and even remotely invested.  It is their responsibility to parent their child, and to overstep that boundary just gives ammunition for not only the child to up the ante, but, risks giving ammunition to others who might benefit the ongoing chaos to have authorities discipline you.

For this example, obviously basically the parents are nowhere to be directly involved, neither of them that I have seen or heard.  So, if that is true that the parents cannot be accessed to intervene, then if you can’t send the child to a safe but neutralizing punishment spot, then marginalize with such pervasiveness and isolation, this kid will realize fairly quickly there is no one to be a sympathetic, supportive ear to bend.  How to do that here?  Don’t support the media this creep uses, don’t respond to forums that give even the semblance of validating his bullshit, and most of all, don’t even try to give some support just because of the now pathetic excuse he was near a mass shooting incident.

Moving on further, then if forced to have to dialogue with either him directly, or his ardent supporters, just note that there is no respectful or validating dialogue to have with a spoiled brat and his mob rule kiddies who are rude and insulting, demanding it’s his/their way or no way.  Sorry, “shut the fuck up” is a legitimate response these days, because whether to Hogg or his allies, they aren’t going to hear anything respectful yet dissenting.  They want utter genuflection or for you to be discarded.

Oh, and the basic premises and defense foundations they shriek in claiming a place in an alleged debate about adult issues like gun control, or free speech, or even of late outwardly being independent and autonomous, they don’t have mature, defensible, reasonable premises to maintain their positions.  SO, they need exposed, they need shown the fraudulent rationales, and they need to be refuted in as brusk yet non threatening ways to be marginalized and ostracized WHEN they refuse to shut up.

Oh, and they will refuse, because the American public has foolishly, cluelessly, and recklessly allowed them too much time and space to shriek as long as they have.

Again, don’t believe me, just hear the rhetoric and narratives.  These people behind Hogg especially, they think they are going to win.  At any cost.  The fact they are trotting out this shit head of no legitimate authority or experience shows they will stoop to pathetic lows to utilize anyone they can manipulate not only as the spokesperson, but the allegedly sympathetic and concerned audience.

Some in the past few days have argued with me my analogy that this is like how Joe McCarthy was able to succeed as long as he did in basically shouting “Communist”, but, it fits for me.  While some have grown displeased with Wikipedia, I provide it below and advise readers to read IT ALL, and see the similarities, not so much with Hogg alone, but with his allies behind the scenes.  It is about silencing anyone who will dare to dissent with them.

Finally, the real opponent of sustained efficacy to end the Hogg shit show has to be someone or some organization that has the strength, stamina, and some respected notoriety that was Edward R Murrow, to be the public and pervasive voice to expose the fraud and disruptions intended, and I copy below from the McCarthy link what Murrow basically said:

No one familiar with the history of this country can deny that congressional committees are useful. It is necessary to investigate before legislating, but the line between investigating and persecuting is a very fine one, and the junior Senator from Wisconsin has stepped over it repeatedly. His primary achievement has been in confusing the public mind, as between the internal and the external threats of Communism. We must not confuse dissent with disloyalty. We must remember always that accusation is not proof and that conviction depends upon evidence and due process of law. We will not walk in fear, one of another. We will not be driven by fear into an age of unreason, if we dig deep in our history and our doctrine, and remember that we are not descended from fearful men—not from men who feared to write, to speak, to associate and to defend causes that were, for the moment, unpopular.

This is no time for men who oppose Senator McCarthy’s methods to keep silent, or for those who approve. We can deny our heritage and our history, but we cannot escape responsibility for the result. There is no way for a citizen of a republic to abdicate his responsibilities. As a nation we have come into our full inheritance at a tender age. We proclaim ourselves, as indeed we are, the defenders of freedom, wherever it continues to exist in the world, but we cannot defend freedom abroad by deserting it at home.

The actions of the junior Senator from Wisconsin have caused alarm and dismay amongst our allies abroad, and given considerable comfort to our enemies. And whose fault is that? Not really his. He didn’t create this situation of fear; he merely exploited it—and rather successfully. Cassius was right: “The fault, dear Brutus, is not in our stars, but in ourselves.

If this cretin is allowed any more legitimate air time to be the immature asshole he has fully shown himself to be, well, then enjoy the encore of what America endured with not only what McCarthy and his cretins pulled off for a few years over 60 years ago, but, a possible current insurrection by the Left and their ilk to truly push America down an already fairly slippery slope of being turned into a travesty of what the country used to be.

The Democrats as a whole are not about the people, not about the public, and not about principles, but just about their party, their partisan plans, and their pervasive need to ruin America to such depths that recovery will not be an option.

Hey, dismiss me and this post, I don’t care about the folks who either want alleged further reasonable and fair debate, nor those who are clueless or just plain complicit to see Democrat agendas be fulfilled.  You folks are already screwed beyond much hope, and I say that with a bit of sadness for those in that position, but, the mensch is not going to be of help here.

No, we are back in kindergarten, and the bullies may act a bit more educated and might have more technology to be effective, but, they are still bullies, they are still immature, and they are still not interested to work with the adults.

Sometimes,  kids need to be spanked, just to remind them there are things bigger and harsher than they think they can be.  Frankly, and I know this to not only be rude and insensitive, but just downright cruel, but, shame the shooter shot up the wrong building.

No one should be murdered, but, maybe the principle to the climax in the movie “The Dead Zone”, isn’t just a movie plot; what if you knew someone was going to cause so much disruption and pain, and you could do something about it prior?  Yeah, while that line of thinking is just outlandish, I am keeping it here.   Maybe a slap in the face for me, but, maybe for others to slap themselves back into line to do the right thing that is productive, effective, and in the end, positive??

Sometimes it is just too late to say or hear, “I wish I could have done something sooner”.  The Left and Democrats depend on the average American to not only say nothing and do nothing, but thank these bastards later after they have screwed the people.

To bring it back to this blog, it is what the Personality Disordered depends on for them to succeed and propagate their agendas and desires.  THINK ABOUT IT!

That’s Murrow, my bet is most wouldn’t recognize him even if they did a decent job reading history and paying attention how shit shows were wiped!!!

Addendum April 3 at 3PM:

Read this from Mr French ( I love writing that!):

He writes there, “Hogg isn’t the bully here. His powerful adult allies are. They built this culture. This is the culture of the progressive corporate boardroom, the progressive academy, and all too many sectors of media and the arts. In this culture, Hogg is a weapon to wield so long as he’s useful. He’s the latest in a long line of victims/activists who spend their time as the “face” of an immense movement, pushed forward by the media until that moment when the news cycle moves on, other victims emerge, and other outrages inflame the masses.”

I respectfully disagree, and I truly enjoy and admire David French’s columns, he probably would have made a decent President, but, he is too smart to do that, hence why he declined the offer made by anti-Trumps about 2 years ago.  Anyway, I disagree because Hogg is not a dumb, manipulated peon, but, he is about to graduate High School, and he knows the system to some degree.  No, he is the bully here, irregardless of who else is being a bigger bully behind him.  Hogg is making a choice, and isn’t that wonderful he has the right to make pathetic, dumb, and reckless choices like he does here!

Because I believe in the right to choice, and even when people make very poor choices, they have that option, and equally deserve the consequences that should follow.  When you have people who think they can make, no, demand others do what is alleged best and appropriate, well, isn’t that tyranny?

Anyway, read the link, and wonder why we tolerate and at the least enable the slime who are trying to remove choice as our right?

No pictures of this loser at this blog, refuse to give him any publicity!


(sorry this post has been basically erased)


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So I woke up Wednesday March 28 in the early AM, came to the computer and read what I wrote Friday March 23 and 24th, and came to the conclusion it was basically worthless and as valuable as a David Hogg shout down.  Thus, I erased it.

But, I keep the post date here to remind me, how pathetic the whole system is, politicians, the public, the oligarchy behind it all…

Sorry to any who wanted it to stay up, but, why?

This is why Trump won

As usual, first the link:

Then key comment from it:

“Of course, Clinton lost the 2016 election because she is a corrupt and unaccomplished fraud. But this is already well known by most people not named Hillary Clinton. What’s far more disturbing is that a great number of her fellow Democrats—perhaps a majority—will find nothing to disagree with in her latest remarks. In their minds, she spoke the simple truth.”

Again, how any alleged respectable, caring, attentive person who identifies with the Democrat Party, well, as a psychiatrist, I sense dissociation at a profound level.

Frankly, I refuse to talk politics anywhere I go anymore, because the few times I hear a Democrat loyalist open their trap, I honestly would love to projectile vomit on him/her!

It’s a shame it is harder to go to the beach in these Democrat enclaves by the coast.  Thank god I don’t go out West for anything.

Oh, and it is equally a shame this witch can’t fall and sustain a head injury that would end her travels among the human race.  Yeah, terrible to write, but, terrible to endure her bullshit further.  Really, how can anyone with an ability to problem solve responsibly say anything positive about her and her narratives?…

Image result for image of Hillary Clinton falling on stairs in India

Wow, just wow is all I can utter from this shot!

People NEED to be frightened…


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It’s been two years since I wrote my series about Personality Disordered Society, ironic I wrote it before the election, even before the two losers were nominated to represent their political partisans, er, parties, which is the real joke here.  Really, what is the difference between Republicans and Democrats at the end of the day?  The former mainly composed of arrogant and clueless Narcissists, and the latter composed of insensitive and thuggish Antisocials, who on cue asked for the same in their leadershit.

Oh, the series’ posts?  They were done in March to April 2016, I’ll link the first 2 and readers can go to the month’s archives to read the rest, 5 more total beyond what I will note here now:

and then part 2:

I would advise readers to read other posts there during that 6 week or so period, as I relate to the role of Personality Disorder to other posts that seem to echo what was, and still is, going on that is driven by Personality Disordered mayhem.

The point to today’s post is based on 2 columns read at  The first well said by Kurt Schlicter, as will be duplicated below:

He ends with this, that I feel echoes my point we are in times that the only rebuttal to the antisocial shit by the Left/Progressives/Liberals/Democrats is simply “SHUT THE FUCK UP!”,  that is a legitimate, deserving response to their shit bag assembly of relentless attacks on honest, appropriate, concerned Americans:

“Civility is not a sign of weakness when a system of reasoned debate is in effect. But it is a sign of weakness, and will be taken as such by our enemies, when we cling to civility because we are too weak and afraid to admit the awful truth, that we are no longer a society ruled by reason but by power.

You want a civil society again? Good – so do I. But the way to get it is not to surrender. It is to defeat those who want to crush you with lawless rulings by leftist judges, with economic warfare launched by woke corporations, and by the steady erosion of the rights your Creator granted you.

If civility means submission, the hell with it. “

and the other column, same source:

The point to this post is more driven by the relentless Dishonest, Disingenuous, and Disdainful efforts by the Main Scream Media driving the lies and distortions the Louts, Regressives, and Libelous want accepted per their agenda of “hear the lies enough and they become truths”.   People, unfortunately, need to be frightened by the extent and frequency of what the “media” is doing of late.  Because those who should make a difference for the better, but instead being indifferent, uninvested, and unconcerned, or by some close to me, overwhelmed and afraid to absorb the conflict, well, we all know what happens when good men and women lie silent while evil tries to endure…

Understand what are the mechanics to Personality Disorder as a general premise, forget specific types.  That is somewhat noted in example in this third part I will include here, but note how this plays out in your day to day interactions, not in the office:

Sorry to echo myself but it need reiterated, from the first column of the 2 sections to Part 3 I wrote:

“It goes back to what I said at an earlier post a week or so ago, we really will see an appreciable rise in depression and anxiety across the country as these two people running for President get the nomination by end of summer.  I really had no awareness of the Democrat convention in 1968 since I was so young, but, I sense I will see a fairly equivalent repeat in Cleveland for the Republican one in July.  And it will be ugly, because it may actually mirror my occasional request to see the equally hideous ends of the pathologically impaired losers trying to force a leader with no real skills to lead the country fight each other to the death.   And those two groups being the elites who just want to rule, rule, rule, versus the angry mob that claims to represent the will of the people, but, the people are not as a majority this polarized, inflexible, and zealot focused folk who want blood.”

Sorry, people might be annoyed or outraged I present this as having fear, but, read Schilicter’s column in full from above at Townhall, He writes it perfectly for me.

burn out redefined

I love this picture, the cover to a Pink Floyd album, “Wish You Were Here”, ironic I really don’t want to wish to be here now…