A veces pienso que debería de escribir la crónica encubierta de lo que sucede con frecuencia en el servicio en el que trabajo. Supongo que ello traería consecuencias... y algunas de ellas no demasiado buenas. Pero, por otra parte, creo que es el momento de escribir la intrahistoria psiquiátrica del emergente servicio de salud mental en la isla de gran canaria (así en minúscula). Por otra parte, podría ahorrarme algún que otro ingrato momento si lo hago, es decir, si lo escribo, en inglés...

So, what is it that I'll do?

abandoning the blog

Sometimes I have the impression thay I am in a sinking ship... or that this blog is an expression of my own personality... (futile ramblings).

Psychiatrie und Ethik

This is a remarkable website. I was very impressed by Wilcocks when I first read his Maelzel's Chess Player (his remarks about Shoshana Felman were what my friend Martin Brown would call a scream). Access to this website is a must for "Freud-bashers" of any ilk, past, present and to-be.

Psychiatrie und Ethik

On suicidal pacts

I have just seen an elderly woman, aged 77 or more, who has survived the death of her husband (by suffocation/asphyxia?). It appears that she also tried to take her life by swallowing a considerable amount of benzodiazepines (the public in general still believe that they are narcotics and continue using this term). Had I been working in England I would have had to call for a MHA assessment with another doctor (her GP) and an ASW (approved social worker); the whole process would have complicated the situation tremendously. As I now work in Spain, I took the unilateral decision of admitting her into hospital involuntarily (for more information of the equivalent of the Mental Health Act in Spain, click here). However, was it legal to do this or, even better, was it ethical? I really do not know... she appeared to be compos mentis. On the other hand, I believe that it was the only sensible thing to do... the risk of her taking her life was too high.

Changing to English

After talking to a patient today, who told me that his blog was in Engish, I decided to switch to this language. First, this is going to keep my English finely honed and second, there is an element of publish or perish; in reality, I have the narcissistic fear that if I do not write in English then I am not going to be read.



In terms of what is happening, I am concerned with the proximity of that very Spanish phenomenon called "Oposiciones." This refers to an exam in which my professional future will be decided for ever (!). Whoa! this is heavy... and close to the notion of tenure in USA and Canadian universities. In the UK, if you are a consultant psychiatrist, you made it! and there isn't a need to prolong this agony of getting some sort of safety net under your job forever...



I have not mentioned before (or have I?) that our Service is organizing an international meeting on Trauma and Mental Health. The reason for mentioning this now is that this topic/theme is fashionable; up to such an extent that it pervades anything and everything in psychiatry. No steps can be given without encountering the word/concept trauma... Certainly this too excessive. I hope to devote more time to this issue in the future.



In terms of what I have been reading recently, I am busy with a quasi-pulp novel, by Paul Malmont, dedicated to heroes of my childhood/adolescence. It was nostalgic (?) to meet again with Doc Savage (who I preferred over The Shadow). For those of my age who enjoyed Buscema's Doc Savage, I recommend this novel wholeheartedly.

El sueño de la razón engendra monstruos

Hi, here again and in English. I am On Call and trying, perhaps not too hard, to survive.

I have just seen a patient with a Delusional Disorder who is implacably mad....

I hope to survive tonight.

Volveré mañana y contaré como me fue la noche.

Trauma, psiquiatría y guardias

Mañana, día 15 de Enero, otra Guardia... padezco de anticipatory anxiety.

Hace unos meses asistí a una conferencia organizada por los laboratorios Wyeth en las Channel Islands (en Guernsey).

Me encontré con un amigo, M.T. Brown, que se había formado conmigo cuando estuve en Southampton; hacía más de 15 años que no lo veía (tendría que hablar de Martin y de este encuentro...).

Fui a un seminario sobre el manejo del Trastorno de Estrés Posttraumático (TEPT) organizado por una de las autoridades (un "Experto") en el sector; no recuerdo su nombre aunque podría ser Chris Freeman, de la Universidad de Edimburgo (aunque una revisión somera y algo superficial de Medline no revela la participación de alguien llamado Freeman en la evaluación y el tratamiento de los supervivientes de la tragedia de la base Piper Alfa en el Mar del Norte). Me llamó la atención el valor que el ponente daba a los "flashbacks"; para él (y para el otro que daba el seminario con él), los llamados "flashbacks" tenían que ocurrir en todas o casi todas las modalidades sensoriales; pero, entonces, pensé yo, ¿No serían, stricto sensu, alucinaciones tactiles, auditivas, olfativas, visuales. En los pacientes con TEPT que he tenido que ver, las imágenes suelen ser fragmentarias... En fin, sería interesante saber algo más del status nosológico de los "Flashbacks" (o imágenes reiterativas intrusas - ¿es válida esta denominación?).