I was reminded this Father’s Day of a story my Dad, a practicing physician for over fifty years, told us about meeting his great uncle just before starting medical school at Tulane in 1943. That Dr. Malone was a country doctor in rural Alabama, the only one for over a hundred miles, serving a poor, rural community. He did complex surgeries, delivered babies and, famously, made his own surgical equipment in his shop behind the house. ( My Dad and brother, Don, an orthopedic surgeon, could have done this if needed, but I lack that talent!). Nearing retirement, he walked my Dad to his basement revealing hundreds of jugs of moonshine whiskey he had received though the years as payment for care! This was standard tender for payment in this area and, often, all his patients had to give. It would be an insult to refuse and, a trueblood Irishman, he could not partake. The jugs remained as a statement of the value this community placed on his service to them. My Dad always laughed at what the new owners must have thought after he passed and they opened the basement door!

I am grateful to the mentoring and role modeling the generations of Dr. Malones have given me in my own life and practice. In Ft. Worth, there was a Dr. Malone attending patients at All Saint’s Hospital for over 56 years until my unit closed three years ago.The pleasures of medical science, a good work ethic, and a sense of service to your community were what I gained from this legacy. Thanks to my Dad, James D. Malone, M.D., for passing this on to me!

A new study explores body image disorders in men, which appear to be on the rise. Body dysmorphic syndrome is fairly universal in adolescent girls and is largely based on a sense of being defective, along with fears of being rejected by women and not attractive to men. Psychotherapy is helpful as is getting involved in a sports activity, where performance matters more than appearance, as well as emphasizing career choices. This is less common in men, but some feel it is on the rise.

Men have traditionally based their self esteem on external success more than looks. Shifting social trends find fewer men pursuing higher education and it is now common for young adult women to out earn their counterparts. Women are also more comfortable in remaining single. Perhaps a thinner waist or bigger biceps will attract a good one!

Psychologically, body dysmorphic syndrome always represents a defective sense of self compensated for by focusing on body shape and appearance. We all want to be healthy and present well, but resolving inner conflicts must come first. The shifting social landscape is also effecting trends in ways never anticipated.

A recent study now confirms suicide is the leading cause of death in the US for people under 50. It is the second leading cause for 16 to 25 year olds, trailing “accidents”. We are concerned about the elderly electing suicide over natural death, but this is statistically low. The folks who live to be old usually do so on purpose! So what is causing these trends?

We live in a land of plenty, with little want, compared with our predecessors, however we are more psychologically disconnected. Isolation, feeling like a burden and fearlessness are the common traits of those completing suicide. Dig deeper and intractable depression, chemical dependency and family and finical stress play a role. We have also lowered the rates of medical illnesses in this age group, allowing suicide to be more predominant. So what can we do to impact this trend?

Refocusing on inner peace and the value of healthy connections is a start. We all wish to succeed in life, but balance is the key. Psychiatric illnesses must be recognized and their treatments valued and funded. Psychotherapy is for everyone. Resolving conflicts and healing relationships takes work. The change in perspective starts with each person individually. Society will follow.  ( We hope!)

A new study confirms that the birth weight and head circumferance measures of babies born to mothers on antidepressants is the same as those on no medications. This study is a part of the ongoing debate of the safety of these medications for pregnant or nursing mothers. No study yet answers the long term effect of medications in utero as they effect the developing brain, particularly the limbic system, where emotions are regulated.

We do know this. Babies of mothers who took medications look better at six months than those who don’t. In the unmedicated group the babies startled more easily and are slower to soothe. The mothers are to distraught to nurture properly. For this reason, and the new study above, pregnant women who need antidepressants are recommended to take them while pregnant. The cost benefit ratio simply works out in favor of active treatment. Psychotherapy is actually very helpful during this time, but in many woman, may not replace medications.

Protecting developing fetuses is a constant concern of medicine, but as the old saying goes, if momma’s not OK, nobody is OK!