Hit

It was supposed to be a clean hit.  They usually were. How can anyone anticipate a sniper bullet ploughing through the back of one’s head and taking the brains to another dimension.

The problem was the bodyguard.  

The hotshots all have bodyguards. You know they’re doing something wrong that they need so many.  Lots of enemies. I personally didn’t care for the guy.  These upstart power mongers were all alike.  Wife and kids and mistress on the side. Lots of talk and no real skill. Not statesmen. Not engineers. Not doctors. Not even judges.  Little snots mostly who pissed off the wrong person. 

 Usually by the time I was called a whole bunch of people were angry.  I didn’t come cheap.  Not that the job was hard. It just carried the maximum penalty if I got caught. Not that I had. And not that I’d come close.

The police are good at catching the angry lover or the brother in law or the business partner. 

They’re not so good at catching beautiful women.  Something about high heels and nylons, cleavage and an unbuttoned blouse made them less likely to consider you.  Of course I’ve always worn dark shades and wigs. But Mano et Mano.  The police, men and women alike, thought with their balls. If someone was shot on their watch it had to be by a man.  By the time they’d considered a woman I was long gone, if they even considered a woman. 

He was sitting in the cafe, just inside the patio. Black suit with black crew neck sweater. I’d watched him order pasta from the white aproned waiter.  He ‘d come in with his bondyguards just like he’d done each week. One of them stood outside at each corner of the patio. . Another was somewhere inside while his closest companion sat at the table with him.  He was talking to him between mouthfuls. He didn’t have good table manors.  Not wrong. Just adolescent. Eating the way a boy eats rather than a man.  Nothing to impress a woman.  Talking with his mouth still full.  The body guard listening to his every word like he was some sort of intelligent. Hired muscle. Thug. I’d listened to their conversations before. Hidden mikes, Surveillance. It was always about sports . Women and spite. He thought himself a great critic of soccer and didn’t like anyone to question his authority.  He talked of women like the same kind of women talked about men. Mostly he talked spite and revenge. No wonder I’d been hired.

I’d worked for billionaires and bedded a few so I knees a millionaire was a wanna be. This guy was a wanna be.  

I got to choose my contracts. That’s the advantage of being private.  Government wet work is so political. Private is financial.  I liked taking out one criminal even knowing another was taking his place. I wasn’t serving the church by any means. My employers whoever they were were unlikely any better even if they did have better table manners. Often they just had better instincts for survival and were ahead in the game. Like now. 

I’d rented the pension a week before.  I told them I liked the view.  It really was.a great view of the street.  3rd floor.  I’d liked to have got further away or higher but the target sat in the cafe and the awning and pillars limited the choice of view.  

I’d worn my starched white blouse and black knee length skirt. Since the owner was male I’d undone the button on my blouse. My uplift bra showed a lot of cleavage and some high end lace. Men are so adolescent. But I do like the rights ones looking there appreciatively.  

For my work though I just want to ensure they dont’ remember my face. Hence the large black glasses, floppy hat, and wig. Today I’d brought the long gun in a cello case.   He actually thought I was with the symphony.  The affected accent helped.  Paying three months in advance.  Avoiding any security cameras.  I had a recording of a classical student practicing cello.  I liked the tune, played it as I watched the cafe and street.

  

The pension had a rear exit. I planned my escape in a parked Citroen I kept in a garage next door. I don’t like to walk too far In high heels especially hauling a cello case. I just had to remember to walk normally. A girl with a cello would be remembered perhaps but not the car, typical of these streets. I worried about traffic jams always but they were as likely to interfere with pursuit and police as they were with me.  

There never was meant to be pursuit. There rarely was. A  girl hasn’t to be prepared for everything. Good thing I was.

I liked the Winchester stainless steel 300 short win mag with Zeis Conquest scope.  Bolt action. I ‘ve got semi auto and auto rifles and guns but there’s nothing like the reliability of the bolt action.  It’s not like I couldn’t fire off a number of shells quickly too.  The longer rifles and single shots were thought more accurate but it all came down to practice and I liked the three shot possibility. I liked the conventionality of the Winchester. 50 mag or alpha would raise too many questions if jettisoned. Not a hunter’s rifle.  I even had a well forged almost valid  hunting license in one of my identities.

Once I’d missed the first shot but got the second.   After my shell hit the mirror behind the targets head tas he moved, there was was so much confusion. The target didn’t adapt quick enough to being prey.  I’d had kill shots at 600 yards but could shoot further. Just never needed too.  The argument for the lapis 338. Magnum  shell was good but I liked the commonness of the 300 wan. . Hard to trace back to me if I had to leave it.  Until now I’d never had to do anything in a rush.  I’d shot a lot of guys too who had body guards.Obviously not as good or bad as these.

I could see his adam’s apple bob as he swallowed.  I’d thought to place the shot below there. Right at the base of his throat where the  neck joins the chest.  Let him drown in his blood.  Nobody was going to live with a 300 win mag chewing up trachea and severing arteries.  I could see there wasn’t an vest there not that a vest would do much good.  Better to be safe. An easy shot.  A mark could move the head at the last second.  Not that I didn’t like head shots.  My trade mark usually but sometimes even a heart shot is all that’s necessary to get the job done. 

I liked to lie on a beach in a bikini listening to the waves and attracting attention of athletic young men and intelligent older men. In my work it pays to be fit and at 35 I was in remarkable shape.  Not that I had to push it to be. I just had a lot of free time given I got a quarter million for a days work not counting the weeks of careful planning. I know some girls like to strip naked and dance for a thousand a night but I thought my gig had that beat hands down.

I really did like to read novels on the beach, eat fresh caught fish and dance slow with a body that I knew would pleasure me late into the night. It’s not like I had anyone to share my loot with.   I did like 5 star accommodations with room service and internet.  Not terribly expensive accommodation with no roof to fix or landscaping to pay for. No property taxes.  Wasn’t Howard Hughes but knew a hotel resort was a good thing. 

 I scuba dived and did photography.  I’d been a life guard when I was young.  I did keep up with martial arts.  Akido. Ju jitsu.  I found myself training in anticipation of work. Knife work, swords.  Whatever seemed of interest at the time. My rifle was my work but one never knew when I might have to rely on a pistol or a blade or even hand to hand to get away. I’d taken a number of fast driving courses too  and was hell on wheels on a motorcycle as well.

Right now I didn’t like his lips. Too full for a man. Kind of pouty.  My trigger finger was squeezing just as he spooned some more pasta from his plate. He was just lifting it from the plate when the silenced rifle made its tell tale sound. 

Zwit . The silenced shot emitted from my rifle.  Emit described the passage better than any other term.  

It should have connected with the base of his throat. But for some reason the body guard had leaned across  the table for god only knows what reason.  He certainly didn’t live  to tell. The shot meant for his boss  entered his ear and took brains and blood out the other side to splash all over the  horrified target who was already falling backwards as the table  collapsed under the weight of the  immediately very dead body guard.  I couldn’t see the target now down on the floor, to take a second shot.  Against all odds the other body guards had moved onto the street and were looking directly in my directions while other patrons obscured the view.  What a botch!

I was up and packing the rifle in it’s cello case, heading out the door, knowing I’d wiped everything and left no clue as I encountered the owner, who as usual wanted to chat with the beautiful girl with the appealing bosom.  I couldn’t stay but also couldn’t rush , so willed myself move slowly, to be polite to laugh and then walk purposelfully down the hall to the stairwell exiting onto the back street.  

I had the keys out of my black cowhide purse and was opening the citroen and placing the cello case in the rear seat. I climbed in the front seat remembered my seat belt and turned on the engine.  Traffick was light.  I drove down the road where high end fashion shops ranged while lovely shade trees lined  the street.  I could hear the police sirens in the distance.  I was free.  I was alive. I breathed slowly and deeply. 

I was leaving the police, the bodyguards, the target, and area.  I didn’t worry after I’d attained the freeway and driven for a half hour to the pier. I stopped there and reviewed events. What I wasn’t free from was the contract.  In my work there’s no room for failure.  Part of planning was having a back up location and shot.  But that would have to wait till another day.  I called the contractor. Explained the problem on the burn phone. Promised I’d deliver before the end of the week.  She was disappointed. It was all there in the tone. 

Then I was leaving the Citroen in the  underground parking lot while I rode the elevator to the loft I had  on the 20th floor. I didn’t like the lack of exits but it suited the profile.  

I put the cello in the closet.  I’m more partial to my rifles than I am to my cars.  I’d trade the Citroen for a common BMW next day.  I’d have to use the breakdown sniper rifle.  For now I’d like some entertainment.

“Marcie? Jan’ Could you come over?” I asked softly.  

Of course she could.  She’d be here in an hour. Just enough time for a shower and change.  I’d wear something loose and sexy.  Marcie was a tough lady I’d first met in a local bar. Drove trucks for a living but was clean and womanly.  Not too butch. We’d had sex that night at her place and I known then  I’d want her again. I had sometimes , not that I preferred blonds.  I liked a cock as much as the next girl  but when things weren’t going so good I preferred a woman who’d care,Already I could imagine Marcie holding me and comforting me. Not that she’d know why I was crying. But I was.  

I don’t like failure.  Now I was going to have to plan the hit with the target on high alert.  

The hot shower on my naked body calmed me.  Marcie arrived and liked the loose long sheer white gown I was wearing. She took me in her arms and hugged me. Her lustful firm body felt good. I said I like cock but I might like breasts more. Marcie’s had busts.   I liked too that she lead me straight to my bed . She has strong hands and liked to give what she calls her baker’s massage. Kneading themuscles like bread doe . Her hands were strong and soft. I was arroused by them especially when she turned me turned me over on my back . 

She’d made me quite naked quite fast.  She herself had been  out of her jeans and cotton shirt wearing just red cotton briefs when she began showing off her tongue, the strongest muscle in the human body.  She had a silver pearling in the middle of it that heightened the erotic. We were at least a couple of hours in bed before I napped all the tension gone and a warm glow in its place. Marcie let herself out. I heard her go.   

Flight Again

Gilbert is with me. He’s below my seat in his carrying bag wearing his Therapy Dog vest, quiet.  Another dog was barking earlier.  He met two sweet dogs in the air port.  A dozen flights now for us. Air Canada and West Jet.

My white Scottie, Stuart and Cat ,Angel had flown Alaska Airlines, to Hawaii, Japan and the Northern Marianas.  They allowed the cat in the cabin and she enjoyed walking about. Unlike Gilbert, Stuart couldn’t fly in the cabin but travelled below deck.  

I don’t know why but now that I’m older the planes crashes I was in come back to mind. The near miss of the high jacking, the RCMP catching the presumed terrorist in Ottawa comes to mind too. I’m thinking more of times I was held hostage at work.  The threats and attacks, physical and verbal, seem near the surface of my mind.  Unlike before I find myself no longer to look back at all the abuse, poor work conditions and constant bullying as the call of duty. We’d do anything for the Naimarks, Hildes and Browns of the day but not for these wannabes today.   

I’ve arrived at an age where I’ve done my time. I’ve served my country, my profession and my fellow man for 40 years.  Working to the highest levels of training and with the least support in the field I’ve persevered.  Like Gilbert below me now, under the seat, I’ve been a good man despite the politics of perfection and abuse. 

 As doctors we have trained at the highest level and served above and beyond the call of duty only because of the paucity of intelligenc in administration. The solution to every problem has been more administration, more meetings and less feet on the ground, less equipment and less beds.

I was promised a place in a 20th century service and spent most of my life working in third world conditions. Horrendous duplication and waste of resources.  Massive mismanagement and now CEO’s paid obscene political apparatchik payments all the while the waitlists are unmanageable and the system flounders under the weight of increasing corruption and stupidity.

I’m flying to see my family in Ontario.  They’ve a new provincial government. The last one defined health care as political correctness, social justice and euthanasia. I’ve never seen doctors more demoralized than they were here where everyone began to whisper.  I’m fed up with the appalling leadership and legal system that simply doesn’t do as it promises and suffers no consequences. Meanwhile we’ve been constantly harangued and perfection has been demanded of us in the front lines.

I complain too much. It’s my mind. I’ve had equally good days and there has been amazing leadership. Indeed I’ve been spoiled by the likes of Dr. Jack Hildes and Dr. Nady el Guebaly, Dr. Bill Bebchuck,  Dr. Bill Brown,  Dr. Graeme Cunningham, Dr. Ray Baker, Dr. Graham ,Dr. Phillip Ney and Dr. Willi Gutowski.

I’ve been appalled at the low brows I’ve come across usually in government services as opposed to the university or private sector. I’m blessed to work with the very best doctors today and consult to the finest doctors and lawyers. When I’ve been being severely castigated for lack of political correctness by those with less training and less experience I’ve had to remind myself that for years I’ve been consulted by the heads of psychiatry, urology, cardiology, family medicine, cancer services and neurology.  You can’t been a bad doctor as the politicos say and be sought by such amazing men and women. I’ve had word of mouth referrals for 40 years. Patients I saw 30 years ago have come back to me. I”ve had the same referring doctors for decades. I’ve seen three generations of patients. I’ve working with the most severely ill, acutely suicidal and dangerously insane. I’ve done general practice delivering a hundred babies and doing surgery, working in the far north and Marianas islands.  I’ve specialized with 4 years of advacnced clipnical training in dual speciality completing psychiatry and two years of community medicine and one year of surgical internship. I’ve furthe subspecialized in addiction medicine, and had a special interest in trauma, first borderline personality disorders, then PTSD, then head injuries and medical consult psychiatric  disorders .  I’ve done so much extra training and workshops in a variety of advanced psycho therapies and psychopharmacologies and been a witness to the supercells court in British Columbia and the American Court in Sipan.  I’ve taught.  I’ve worked with Insurance Companies, the courts, Veteran Affairs. I say this because the gaslighting beurocrate do anything to undermine honest clinicians, especially “whistle blowers”. And I’ve had to be a whistle blowing stopping countless deaths because those tasked and paid o do this job have been negligent. Now today, political correctness is more important than morbidity or mortality. It’s okay if the patient dies so long as the electronic chart is pretty.

Yet I’ve faced lying psychopaths and their advocates, what Isaiah called the ‘long necked women ‘ and their ‘boys.’  A socialpath in power said “women don’t lie about sex’.  Meanwhile a drug addicted ex prostitute was shaking me down for money and another sociopath was running a business scam and angry that I by my honesty and dedication to duty called them on their deceit.  I was condemned as “confrontational”. It was considered “confrontational to make a diagnosis of addiction or malingering”. Even factious disorder was frowned on. Increasingly we were told to not practice textbook high quality medicine and psychiatry because it might offend the one in a thousand ever looking to be offended and lying as routinely. 999 could get substandard medical care just so the one was not offended. I was told the “customer” is always right and advised the health care was a consumer industry. 

Now I’m struggling every day to overcome the back stabbing behaviour of the government and country that I served where the leadership has become evil and corrupted.  I’m like so many of the solders , police , professionals and orthodox I see asking what happened. When did the leadership become down so totalitarian and paranoid about the citizens. When did they chuck accountability altogether wasting billions of tax payer money on one hair brained self serving idea or program after another.   Every good person I know is asking this question. Every good person I admire is being attacked outright by management who seems greedy and stupid as a post. The government here is actually caught in casino and real estate money laundering. Gangs are shooting it out. They’re manufacturing their own guns. People are being attacked by trucks. I pray ‘forgive them for they know not what they do!’

Then I look at myself and see a ‘resentment’. I’m holding onto this past abuse. It’s triggered by the season. I am aging and the bitterness comes as a flavour solely becaus I suck the tit of despair.  Jesus loves me. I have friends and family that love me. Surely Gilbert loves me but I devoted myself to work and lost marriages and fortunes by honesty and duty.  I look at the corrupt and see them apparently succeeding.  All the criminals I knew who grew marijuana and did drugs and brokethe law are rewarded today.  Billions of dollars of government deceit has been rewarded and all those who were corrupt and dishonest and in bed with the criminals are celebrating their lawlessness. 

Meanwhile I’m a Boy Scout I’ve been a Boy Scout and they called me a ‘non Tek player’. I said don’t leave the bodies on my doorstep and don’t include me in your latest scam. 

.I see our stoner PM giving Ten Million dollars to a terrorist who attacked Americans. Those I thought were our greatest ally but somehow we’re in bed with dictatorships. My faith in common decency is shaken.

Meanwhile I’m the one stealing my joy., condemning myself, holding onto resentments. I’m reading the catastrophizing fear monger if news. I’m begging to think the glass is not half full. 

  Forgive them for they know not what they do.  They are not human.  I am here at Christmas come to see the birth of Jesus and celebrate the incarnation of God in this life.  With his death and resurrection at Easter he shows us that this world is temporary, the Herrods and Sadduccees and Judges are in error. He throws the money lenders out of the temple. his Apostles are crucified. Herod and Pilate are villains like the beurocrats of Neuremburg. Meanwhile Peter , a lowly fisher man is revered as a saint.  

I am wrong to fault others. The error has been mine. A wiser person would have done the same and not been hurt. I would have formed a committeee or taken wiser advise and saved my self the injury of filthy women whose greed and lust soiled their souls long ago. They used their bodies to seduce the men and women who advocated for them.  Those who bear false witness are in the ascendancy because the very system of truth is under attack by the communist postmodernist  devolution of society.  I’m just caught up in a shit hole that is a cultural war.

Yet my job is to pray for my enemies. I’m not to rent them a place in my mind for free.

I’m supposed to be experiencing joy. I’m supposed to be counting my blessings. I’m supposed to be filled with gratitude.  Yet I don’t sleep more than a few hours. I’m overwhelmed by work. I’m struggling to pay off a truck. I’m uncertain about my future. I can’t decide how long to work. I am filled with fear at the prospect of aging. I’m facing more and more physical limitations and don’t know what to do this year since I might not be able to do something next year.  I’m fearful of making mistakes.  I’ve less life and it’s now prescious.  I criticize the administration and yet I feel like I’ve wasted my own life. I’ve been drawn into other peoples struggles .I’m a regular mercenary for the underdog.  

I must pray more to God.  I must show discernment. I must get beyond self pity and must avoid bitterness. I must look for the good. I need to do this .  It’s paramount.  I’m dying sadly because I don’t focus on the positive. There is no benefit for me fighting the good fight.  I deserve a break. I deserve to be able to leave the battle field.  

But 35% of society are still supporting this communist take over.  I’m afraid that if I don’t remain now I’ll be brutalized in a nursing home some day by these sociopaths ivying for power. I fought for my patients daily and weekly, constantly punished for making the system work the way it was supposed to and not by ‘who you are’ and ‘who you know’.  I’ve served so many under dogs and under dog causes.  The rural hospital, the northern nursing clinics, the mental hospital wards, the asylum, the Aids epidemic and the tenanyl epidemic. I’ve gone where no one else would go. I’ve served in the communities with the greatest need.  I sought most to serve God.  

Now I am not feeling close to God because I’ve been waylaid by ego and inferiority. I’m ashamed of my lack of achievement and worry at the waste of life I’ve encountered doing good and being good. Now I’m all for hedonism and pleasure and am if anything too old for this after so much sacrifice and really is this not a bit of bullshit. When I’m honest I’ve had a great life and that’s the problem. 

I look at my past and see the failure only because my search engine is flawed. I’ve had a great life. I’ve done andseen  marvellous things. I’ve been blessed to be married to the most beautiful and sexiest women, most brilliant women on the planet earth. I’ve divorced them too.  Ive bought the one sided lie that is the divide and conquer of the infantile court. Ive failed all those women and men but The reason never was heard in any court. 50% divorce rate today and judge no better at love than a society increasingly godless.

I’ve had friends to die for. I’ve had wonderful dog companions. I’ve studied the most extraordinary sciences and still I’m fascinated with science, Medina, the mind,  history and spirituality.  I’ve maintained my interest in chemistry. I know my psychiatry and work still but more and more I’m reading history. I just read a neurochemistry text and was not so excited as I am by the travel of religions. Younger I visited NASA. 

I loved going through the hallowed shrines of Oxford, Cambridge, Harvard and Stanford . These were the highest churches of advanced learning. I was blessed to be at the universities I studies and taught at. I still take night school and on line courses. I even dream of taking classes in the future in these places .I miss libraries and writing papers, doing more formal research and having time to read th books that sit in stacks about my home. The books I’ve been reading I finish so slowly because there are so many distractions of lesser value. 

I read and read and yet I’ve not written the books I’ve considered. I long to write.  I don’t want to waste my time reviewing the assholes I’ve known. I’d rather write about the saints and genius and the women of great love and extraordinary skills of the mind and in the bed room. I’d like to write like Lawrence of the men I knew and what I learned. 

It’s almost 2019.  I have known several near death experiences.  I’ve been in so many crashes, cars, trucks, motorcycles, planes.  I’ve been shot at. I’ve faced guns pointed in my face. I’ve been knifed. I’d  been locked up and threatened by my jailor.  I can’t forget the words and the threats.  I remembered those recently and it blotted ou the good of that day because I let it. I let this sociopath threatening me with all his abuse of power come back into my mind all the while I know he will burn in hell.   He has no soul. He’s a capo.  Stupid man vain man. A hollow man. 

Now I’m twisted and hurt and wounded and I need to focus on the light .  Shadows jump out into my path and I let them derail me. I must walk in the light and focus on the light.  It’s hard but it’s harder not to do it. 

Here is a perfect day. I’m above the clouds in a jet plane. The sun is shining. I’m flying from friends to family with the greatest of companion dogs.  I’m blessed. God is great all of the time.  I must look heavenward and let go of the hell ive known while nurturing too the joys  I’ve been blessed with. I must stop being an ingrate and becoming more forgiving as Jesus is, was, and ever shall be. 

DSM5 and Psychiatric Research

DSM5 was never meant to be a ‘cookbook’.  Indeed the classic criticism of the DSM series is just that.  I see this increasingly with personality disorders and worse the attemp to use psychiatric as a weapon in recent political debates. I was a member of the Psychiatrists against Political Abuse of Psychiatry at a time when communists were calling all who disagreed with left wing ideology, schizophrenics. 

 My favorite clinical example of mis diagnosis was a very arrogant  oriental female elitist academic psychiatrist calling a very black regai singer manic depressive without considering of context or work.  The reggae singer’s response to the misdiagnosis was ‘at least I don’t squeak when I walk like that up tight bitch.’  

The DSM especially regarding personality disorders and traits was to be taken in their historical context. Everyone has the ‘trait’s that are described in borderline, narcissistic, ocd and paranoid or schizotypal personality disorders. The key to the diagnosis is that the over abundance of certain traits or coping mechanisms has been a problem starting in adolescence and causing disturbance in a person capacity to work, love and play.

Mental healths simply defined is the ability to work, love and play.  I was annoyed to hear a colleague, clearly envious, call a lawyer we knew ‘narcissistic’.  Of course he has narcissitic traits,  There’s healthy narcissism and unhealthy narcissism. His daily work with unhealthy narcissistic sociopaths and psychopaths required he develop in his ‘persona’ character ‘armor’ to do his job.  He was very successful in his work, was a husband with several children married to a lovely wife happy in her family and career. He had a number of past times he enjoyed with his friends and family and definitely liked to play water sports among others. 

Borderline traits are commonly bandied about because it’s common today to hear those who value and devalue and have quite shallow short term relationships and are very angry a lot of the time.  Projection and projective identification with dissociation are common in those with the personality disorder but the full personality disorder implies that the person didn’t really leave the teen age era of personality disorder, often called 13 years old going on 40.  Yet border line personality traits are common coping strategies after trauma.  Borderline personality disorder has indeed been called untreated ptsd and Borderline Personality Disorder traits are common following PTSD where the stressors are ongoing.

Abnormal coping mechanisms doesn’t mean a person is ‘bad’ anymore than abnormal sugars doesn’t mean a person is diabetic or that diabetics are necessarily diseased.

To understand psychiatric diagnosis in context it’s necessary to understand that people commonly diagnosis themselves with physician illness and their neighbor with psychiatric illness.

Further the popular media is extremely ‘off’ with regards to psychiatry tending to make a very big deal about some aspect of psychiatric research when indeed the research of psychological studies in prominent journals showing that although 97% of the major journal results are ‘statistically significant’ after a year less that 40% are valid on replication.  

Evidence based research and the Cochran’s trials are extremely open to error in psychiatry which is a combination of neurology, psychology, sociology and anthropology.  There’s mentalism and materialism competing in a marvelous soup of 3 dimensional chess proportions all being routinely deducted by  players with secondary gain issues like insurance companies, courts and drug companies .  There is further always a private and public health consideration that only infectious disease in ‘physical’ medicine seems to truly have.  The mind simply is not the brain but reductionism and pseudoscience would explain everything in eloquent terms that are simply not true for individuals though generalizable to some extent.

I’ve probably got most expertise in non compliant and resistant diagnosis in addition to addiction and trauma patients. I see anxiety and depression as the phenotyic expression and use medications that are generally non specific despite the specificity of diagnosis on occasion.  

I love Dr. Milton Erickson’s expression, when he said “we can all agree that the pot is cooked and we must get it off the fire but everyone argues about where the handle on the pot is until someone realizes they have a pot holder in their hand and pick up the pot, which is what everyone agreed needed doing.’

There is however ‘secondary gain’.  When a person isn’t getting better with the standard treatments psychiatrists ask what is the advantage of this disability. I used to diagnose malingering and have correctly diagnosed dozens of fraudulent patients. Malinger is conscious fraud whereas fictitious disorders are unconscious fraud.  I eventually got told to stop taking wheel chairs away from people who while quite able to walk were using the wheel chair as a ‘prop’ to get more money in some claim. Offended by my correct diagnosis I was eventually told that only a judge today can make a true diagnosis of malingering despite it long being a psychiatric diagnosis along with anti social personality disorder. A patient became very angry with me because I diagnosed them correctly as an antisocial personality disorder because it was going to affect their getting their restrictions reduced.

I mention this because the ‘popularity’ of a diagnosis is commonly affecting diagnosis especially when patients have the power to cost a doctor tens of thousands of dollars if they make an unpopular diagnosis . Having made hundreds of diagnosis of alocholism and addiction I was one of the most unpopular doctors and especially so when I diagnosed pedophiles and violently dangerously insane people who wanted and sometimes threatened me to make their diagnosis something that would improve them financially.

When I see a ‘popular’ psychiatrist I immediately doubt he or she has diagnosed addiction or pedophiles. Forensic psychiatrists are not commonly ‘popular’ where as general practitioners historically were. I was indeed extremely popular as a family physician and patients who didn’t like me went to my colleagues leaving me with an interesting assortment of patients who liked my ‘truthfullness’ and routinely stated they appreciated that I didn’t ‘mince words’ .  Compared to my fellow family physicians I was more ‘patient’ with patients and listened to them ad infinitum being very interested in their ‘story’. Compared to some of my colleagues being an addiction psychiatrists I’m less ‘patient’ with the ‘story’ because addiction commonly hustle and ‘work’ the story and ‘try out the story’ in an attempt to obtain another ‘enabler’.  So if a person has an addiction they will want you to believe and ‘cut them some slack’ agreeing with the disease the problem isn’t their continued use of crack and alcohol or even heroin but rather it was the parenting.  

Pscychoanalysts being paid listens and analysed addicts to the tune of millions but this ‘therapy’ simply didn’t change behavior.  Addicts and alcoholics were quite content to do anything as long as they could continue their addiction which Freud considered worse than schizophrenia.  Motivation therapy and 12 step facilitation therapies the most effective therapies in addiction focus on behavior therapy not ‘intellectualization’ which is common with addiction.

These are all context and developmental considerations in diagnosis of psychiatrists. Further in contrast to neurolgy, psychiatry is commonly one on one without the capacity to ‘triagulate’.  Triangulation is where the therapist can say, “I’m not saying you have cancer, your CTSCan says you have cancer’.

There’s simply no pictures in psychiatry that “make diagnosis’.  No lab tests’.

So indeed many diagnosis in psychiatry are culturally limited as they are comparisons against a norm which might well be antequated. I have argued that the MMPI a personality profile developed in the 50s and still popular in the legal system today is long past it’s shelf life.  Many of the personality tests preceded the social rise of LBGQ movement and the very ideas of ‘disorder’ implies an ‘order’ which might well be past. 

Further psychiatric diagnosis and treatment and research is about providing care for the ‘individual’. I did a dual speciality in community medicine and public health and psychiatry and the two fields public and individual medicine are diametrically opposed. So in psychiatry today I am acutely aware of the distinct difference between publicly funded health care diagnosis and decision and privately funded health care. In the area of addiction , the elite are offered abstinence therapy and the poor are offered ‘harm reduction therapy. I am forever making myself unpopular saying that I’ll recommend ‘harm reduction therapy’ as a first line treatment to the poor when we accept heroin treatment for judges and doctors and pilots. One therapy is cheap immediately while the other abstinence based therapy is usually more costly.  Betty Ford Treatment Centre versus a drug therapy.

Similarly the decision to diagnosis a person schizophrenic versus manic depressive or schizoaffective has profound life effects for a person and yet psychiatric diagnosis are ‘venn’ diagram. I’m frankly bored when I hear some people talk with the kind of confidence that only the truly stupid can have. I’m forever uncertain but happy to defend a ‘working diagnosis’ and as a ‘treating psychiatrist’ versus and academic or one of those who avoid or rarely see patience, live in the present and in reality. There are serious limits to what is available for most patients given that psychiatric patients are the most stigmatized and most marginalized.  We simply don’t have enough psychiatrists and psychiatrists are the most poorly paid so commonly attract the least assertive practitioners.  At one end of the psychiatric spectrum are soft psychiatrists who prefer to hang with counsellors and at the other end the ‘hard’ psychiatrists who like to work with neurosurgeons. I’ve moved up and down the spectrum also noted a wide variety between the ‘american’ based psychiatrists and the ‘British based psychiatrists’ who have trained in the ICD.  

Of course you can use DSM5 as a cook book and get away with it.  Indeed the joy of medicine is that the majority of patients respond to standard treatments.  This makes family medicine so enjoyable because historically the truly complicated cases were supposed to be the realm of specialists.  Unfortunately that model failed in where there were insufficient family physicians and insufficient specialists.  

The joy of psychiatric specialist practice is diagnosing and treating the patient who has not responded to standard treatment or been misdiagnosed or is resistant to treatment except that today there is little approach for this . The one shoe fits all approach goes with give a boy a hammer and everything is a nail.

The joy of psychiatry was assessing transference and countertransference but like ‘secondary gain’ they have gone the way side. Sadly without those psychiatry is reduced even further to being a ‘junior neurologist’ field for those who don’t really want to do the grueling research training demanded in adult neurology.  

Canadian Authors Association Metro Vancouver Branch 2018 Annual Meeting

What a joy to see the old young faces again.  Bernie had been bugging me to leave my work and come out and play. Jean was radiant. Margaret was stunning. Forrest so obviously happy and proud. Margot still whimsical. Joyce and Peter, lyrical. Llilija conspiratorial. And that was just on the outside. The depth of all these characters so evident in the genius of the works.  There were dozens of new faces and I’d only been away a year or two that seemed like just yesterday.  

Pens, and typewriters had been wholly displaced by word processors now displaced by telepathic mind meld machines  linking all directly to the world internet.   People still called themselves authors. They spoke of fiction and non fiction.  Auto bio and bio. Poetry and prose.  What Home Security missed the Chinese were glad to catch. Hidden cameras everywhere and drones.  I thought the waiter mght well be a spy from the Federation or at very least the Writer’s Union.  

The book remains an art form, tangible, immutable. They were being launched all the while I was away.  Great ideas cast out to the masses and picked up by orbitting satellites. Martians didn’t understand our news but did so love Earth’s  poetry.  Digital no longer held solely clinical connotations. 

Names like Kindle,Amazon, Wordpress and Google were bandied about. The Old Spaghetti Factory was a terrific venue.  The conversations flowed.  Laughter entwined. Introverts hardly ever out of their garrets listened for bon mots they could put in the mouths of heroine lab rats fighting for better work conditions.   I felt warm and fuzzy disarmed by consecutive hugs by authors.  I felt like a good read on an autumn afternoon. There were sounds of bubbling brooks and ocean surf in the back ground.  

It’s such a solitary activity writing. Days and years of intense mental masturbation culminating in a disgusting public debauchery spectacle of marketting and interviews.  There is even money dropped here and there like crumbs in a treasure hunt.  There are even formulas for the babies and for those who tire of genius and obscurity. Pornography sells.  Fifty Shades and that’s okay. The person in the corner over there beside the pretty children’s book author once wrote political speeches. A lurking newswriter with tobacco stained fingers only shares his psychedelic love poetry here. The sweetest little thing in tailored blouses is noted for her messy murders. We all have our secrets.  We’ll put yours in a book if its a doozy or ours have passed their shelf life.

I used to lunch with the executive and board.  There’s always room for service. This writer's organization is the oldest in Canada. Subtle.  Writer’s helping writers.   At the lunch we’d discuss who we wanted to invite to the monthly meetings of the association.   I loved the monthly meetings . We met publishers, agents, advertisers, television producers and all these other dull moths who circle the heavenly light of  authors.  What I found was that to my shock  they were really interesting people who had fascinating lives and loved authors, books and poetry, like any other garden variety fetishist.  I learned alot from them.  

I also met some of my all time favourite writers, those major hits with books sold at the supermarket check out counters and in airport kiosks. This gave a face for my envy.  Later  I could perfect my voodoo dolls and sharpen the needles and pins. Meanwhile I’d read all of their works.  

The presidents, past preidents, new presidents and treasurers and secretaries all had their say.  It was brief.  Authors may mince their words but they don’t waste them. Some actually punctuate.   I was sad to leave but for me it was a work night. What a fabulous group.

But then if you write, as we all do ,being among other writers is like being at home. I compare it to a ward of multiple personality disorders who have avoided the butterfly nets.  They actually admit to hearing voices but call them their ‘muse’.  A thoroughly entertaining eccentric lot. The price of admission and belonging is a more like a haiku than a sonnet. 

Advent Rant

The insecure always demand imitation.
The unshared terror is that if everyone is not the same,
The tribe dies for the sins of the one.
You must believe as I do
Otherwise you’re in denial.

Superstitions, constructionism, satan in disguise,
Bad beurocrats, jaundiced judges, banal  bankers, agitated accountants,
the status quo rich, appeasing academics, humilitaring hierarchals,
pathetic politicians, devilish drug dealers, affectionate arms dealers,
Tobacco board members  and craven corporate lords,
Orchestrate and conduct, deaf to the music,
Celestial spheres and harmonics of conscience.

 The truest protest is poetic silence.
The encription in the pauses and stops,
SOS  in empty spaces aligned just right,
read from left to right.

What is said can and will be used against you.

I am myself unique in DNA ,but cut from the same cloth.
The apple never falls far from the tree.
The snake is never sleeping.

Wallace and Ataturk shake
Elvis sings a Christmas Carole
Bach is busy at the keys.

Hollywood festers.
The circus always  in town.
What goes on in refugee camps and palaces
Stays in refugee camps and palaces.

But I must act like you who are afraid.
Invasion of the Body Snatchers.
I wondered if I should wear a tie and asked if you did.

 South African farmers pay in blood
for those ignoring Nepal and  the Armenian crucified.
Again, why were they purposely sacrificed?
The Holocaust is but the champagne of sparkling wines.

Insufferable Canadian urbanites protest the latest subtle offence
Ignore the blood running in rivers
And fire ants descending on honey pots the world over.

Your fear is palpable
you are so disconnected
you do not feel your fear
or your anger

Offering heroin or assisted suicide,
you insist as always you offer “Choice"


Herod killed thousands of children
Hoping to kill the one.
You  aborted millions to save face.
How many saviours, Heisenbergs, holy men, Buckminster Fullers
And Madame Currie’s  did you kill
to create your fear of Climate Change.

Still He lives
Again we celebrate Christ MASS.
He lives. He dies. He is Risen.
Jesus Christ comes again.
I’m  guessing I'll wear the tie til then.


.

Crinoline and Blood

When I said I wore panties and liked the feel,
There was no blood
The blue wool dress hung straight;
But you said you liked the cammo fabric,
That felt  rough as war,
Spotted with blood,
Thankfully not my own
Though would it matter?
You prefer men that fight
Preferably in silks.
Crinoline and beards so unbecoming.
.

Genius and Psychosis

Thanks to very fine teachers I used my time in training on call studying the long history of psychiatry.  I read the original works of Jung and Freud , Reich, Adler, and later Frankl, Menninger, Erickson.  It was in their personal writings that so many of the most profound insights were recorded. I love R. D. Laing living with Schizophrenics and the original community projects and other experiments that clarified modern ideas of mental illness.

 Today too much emphasis is placed on the ‘evidence based’ scientific study since it’s inherent limitations are the money and selection of the research that such studies so commonly are designed for.  Clearly the Grant Study like the Framingham study, prospective studies with profound insight are a step above so many others.

I liked the original observers who questioned matters like ‘secondary gain’ and considered the ‘advantages of insaneity’ and why it persisted.  What ‘value’ did these states have.  The disease model has been so fixed on eradication without consideration of the benefits.  The studies of distribution and the genetic studies of the turn of the century showing a crazy aunt or uncle in the attic of all the greatest of the New England seaboard were that kind of insight.

I liked the the studies which showed the relationship of genius to Schizoprehnia.  What was the difference between the grandiose idea of the manic depressive and the grandiose idea of the great creator, statesman or artists. 

Today there’s a beurocratic emphasis on the median and mediocrity whereas that was not always the case.  I fear that the end of the world is more likely to follow such stultifying reductionism than it is to any cataclysmic world event.  There’s a wearing tedium to this safe thinking and safe behaviour and emphasis on safety that has been shown associated with the fall of great eampiers and not associated with the greatest breakthroughs. Science is the world of wonder and daring whereas too often the politics of today is based on fear rather than belief. 

In my own work with geniuses and with schizophrenics and manic depressives I’ve I saw  that often the only real distinction was in the outcome of the ideas as opposed to the variation. Both the ideas of a mad man and the ideas of a genius are equally frightening and alien. This explains the common concept of ‘awe’ before encounters with God.  It is difficult to maintain an open mind and more easy to take the safer route of being closed minded.

Yet to the mediocre genius is wholly alien.  

Now having met folk who feel that eating their neighbours would be a great idea there’s limits to one’s open mindedness especially if one is the close most proximal neighbour to this ideology.  Yet that’s less a concern than the tendency to reduce the possible to the limits of the mediocre especially where there is fear and frank cowardice.  

Every day we live with miracles that would have had us shot, locked up or burnt at the stake were it not for risk taking and open mindedness.  I thinkit’s  important to embrace genius and also to have the humility to recognize that genius is commonly so much beyond the scale of one’s own conception. It’s childlike in wonder.  It’s birthplace is curiosity and I would add love.  

I truly am thankful to have had the privilege to have known genius, rare and wonderful and struggling to relate in a world where they are not the masses. To the majority, their genius was not so much as blessing as a curse.