The Frontier Psychiatrists

Owen Scott Muir, M.D.
The Frontier Psychiatrists

The Frontier Psychiatrists Substack has this companion podcast. Owen Scott Muir, M.D. is a writer, physician, scientist, and podcaster, bringing content about healthcare that is personal, weird, and less boring than most of the things you’ve heard. Subscribe at https://thefrontierpsychiatrists.substack.com/ thefrontierpsychiatrists.substack.com

  1. JUN 22

    How Can We Treat Bipolar Disorder in the Global South?

    I was invited, thanks to the magnificent and only-ever-positive internet, to give a lecture to colleagues in Nigeria. I’m kidding, a little—the internet can be rough. Ask a comment section of a YouTube video! However, it is also a technology that has brought the world closer together. One of those less absurd corners of the internet is LinkedIn—it’s like the world’s most boring dad and his boss decided to invite you to a global-scale compliance educational module. “So exciting, it’s mandatory!” I am giving the internet a hard time. Sometimes it’s a special kind of magic. Like, for example, today. Imagine you are a progressive hospital system in Lagos, such as Gracehill Hospital. Yes, that is in Nigeria. It’s a progressive country, compared to the rest of the continent, but some of that progress is recent, as in 2023. A new Mental Health law was recently enacted in Nigeria to replace the Lunacy Ordinance of 1958. The passage of the new law was a major leap from the old. It was received with excitement because the former law was not only outdated but failed to address core issues such as the promotion of mental health and the protection of the rights of the mentally ill. If you're looking to move your healthcare system into the future, you might want to consider finding speakers for your grand rounds. With Zoom, it’s easy to host hundreds of people. On LinkedIn, you can see professionals posting about what they are up to. And, if you're bold, you can simply ask one of those folks to speak. Which is what happened to me, and how I found myself drafting a lecture on Bipolar Disorder for an audience of Nigerian (and global—many people, both professionals, patients, and family members attend these seminars!). Nigeria has an estimated 250 practicing psychiatrists for a population of over 220 million (WHO, 2023), amounting to roughly one psychiatrist per 880,000 people. I probably spoke to 1/4 of them yesterday. There are substantial barriers to mental health care in Nigeria—much if it financial. According to the World Bank, Nigeria’s Gross National Income (GNI) per capita in 2023 was $2,460 USD. Fewer than 10% of Nigerians have health insurance. Those plans cost $250+ a year, but mental health parity doesn’t exist, and thus those services are only covered under yet more expensive plans. To draw a direct comparison, Nigeria has 0.11 psychiatrists /100,000 population. This is similar to Kenya (0.2/100,000) but with 400% more money budgeted to address the care of the population. The US has 13/100,000 and spends about 6.2% of its health budget on mental health care. The question, globally, is how to do more for our patients with less harm and at lower cost. One interventional treatment is considered essential—and its ECT. The WHO's keep an “essential medicines” list! Nigeria has access to ECT. Lithium is also an essential medicine. TMS is not on that list, yet. Maybe, I posit, it should be? What follows in this podcast is the talk I gave. Thanks for reading— and listening. A huge shout out to my gracious hosts at GraceHill, and their Partners, who make this series possible! The Frontier Psychiatrists is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. If you are interested in the Validation Institute’s award for Best Mental Health Treatment in 2024, consider Radial. It’s where I work, and with locations across the US already, we are working to bring the most advanced mental health care to everyone and make it accessible. If you are looking for help, Radial offers the most advanced mental health care. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

    30 min
  2. MAY 26

    Say His Name: Five Years Since Mr. George Floyd

    Author’s Note: This writing was adapted from a series of conversations around race in America and edited as audio, recorded in 2020, right after George Floyd was lynched.. The podcast of this writing is the real thing, as it were.  What follows is edited text to clarify the narrators, absent the audio.  Please consider following the podcast associated with this newsletter and leaving a 5-star review on Spotify or Apple Podcasts. Please subscribe to support high-impact content like this. The author, David Foster Wallace, described the experience of reading his novel Infinite Jest as intended to feel “tornadic,” like you're in the middle of a tornado. That's what the last several weeks have felt like. Protesters: "Racist ass police! No justice, no peace! F**k these racist ass police! No justice, no peace!" "F**k these racist ass police!" Owen Muir, M.D.: I originally tried making this episode a linear narrative, but it wasn't happening. So, welcome to the tornado of racism in America. Buckle up. George Floyd spent 8 minutes and 46 seconds gasping for breath.  Police officers, some of whom were very experienced, knelt on his back...until he didn't breathe anymore. As a psychiatrist, I often emphasize how the words we use to describe someone's death have meaning. So, I'll say, you know, completed suicide, not “commit.” And George Floyd was lynched. Welcome. This is about anxiety, uncertainty, and existential despair. And I recorded the narration in one take because I wasn't, like, going to get it right a second time. So much of what we say about race is calculated, polite, and wrong. So I'm not going to try to do that tonight. Here we go. Sequoiah: "Yeah. My general reaction to all this is a little more, a little more extended. The, uh, f**k". Owen Muir, M.D.: That's my teammate. She is a TMS technician at the mental health practice we worked at together. She also works in the community with patients helping put their lives together, but tonight she's a field reporter on the revolution. Sequoiah: "I am a TMS tech, Winnicott coach, and black woman. Which seems very important right now. George Floyd, Say His Name.  George Floyd, Say his Name. So I just got home from a protest in Flatbush. Police would not let us pass. We were chanting with our hands up. And after a while, they decided to push the line backward. We resisted—we stood there with our hands up. They pushed us and pushed us, and when we wouldn't..." Owen: Now, as someone with a lot of white privilege, I'm outraged at hearing this, like, wow, this is f****d up. So I called another colleague in the special operations community, and I'm not using names in this episode for semi-obvious reasons, and I heard what he had to say. Master Sergeant: “The things that U. S. police forces are apparently fully within their legal rights to do, like, use tear gas, would literally have…been against the Geneva Conventions. It's an actual war crime. We cannot gas a civilian population.” Owen Muir, M.D.: The person I’m interviewing has over a decade of experience in the special operations community. He has fought and killed for our right to do what my other colleagues were in the street doing, peacefully protesting. Master Sergeant: "This is a perversion of what the United States stands for. We invade countries who treat their people the way that our police forces are on camera treating Americans " Sequoiah: "People started to back up, , and run and they then started to hit us with batons. , I fell. And then we reformed the line." Master Sergeant: "It's disgusting in a lot of ways." Owen Muir, M.D.: So when someone whose life has been dedicated to protecting our freedoms tells me they're upset with what they're seeing, I take that pretty seriously. Sequoiah: "Well, the other night, well, last night, when the cops and protestors were getting into, into fights and they were trying to, the cops were trying to push back the protestors, I saw them bring out the batons and, like, start attacking people...and each time they'd tell us to back up and back up and kept pushing us and pushing us. And finally, there was a frustration in the air, and people started to act out." Owen Muir, M.D.: Now, as a psychiatrist, my life has been saved by police officers on more than one occasion. I have been physically attacked in hospital settings.  The police have been called, and I have not died, and my colleagues have not died thanks to them. And this is Flatbush, Brooklyn, New York, and these people are black people. The Flatbush, at least the area I was in, is a predominantly black neighborhood.  So, look, Americans love the police.  They are a highly regarded part of society by many people, but that's not the experience for black America I have learned. Master Sergeant: “There are many things you can do in that spectrum that don't involve actively using force against a human being, which makes the process easier across the board. If I don't have to hurt somebody, the only thing that is hurting another person does for me is further endanger my Troops. " Owen Muir, M.D.: Now this makes sense to me because, having run the show in a psychiatric emergency department, where I have to protect myself, other patients, and violent people themselves from getting hurt, sometimes we use violence, but oftentimes we don't. Master Sergeant: "What started this particular instance has been four cops lynched George Floyd. One guy put his knee on the man. We don't do that to terrorists actively trying to kill us. " "George Floyd, Say His Name." Sequoiah: "It was at that point that they called in more backup and started to attack and arrest groups of gathered people from the neighborhood.” Owen Muir, M.D.: Police officers, when they're called to stand trial for the use of force, have a standard called the reasonable officer standard. I feel like I have to make it relevant for me--a white person—to watch humans being murdered by police and then people killing each other in the streets about it. There was an article I read about six months ago about yet another person being slammed to the ground, handcuffed behind their back, and suffocated to death by the police. I was shocked..that the person was white. Until I read several paragraphs down that he had schizophrenia. Oh, that's what made it okay. Reasonable officers can only be judged based on what someone would do in that moment of terror when they have to decide to use force. Sequoiah: "I was so emotionally spent and so exhausted. And then we saw marauding bands of police officers going down the street, just telling people to go home and attacking groups of people on the street.” "George Floyd, Say His Name.  George Floyd, Say His Name." Owen Muir, M.D.: Police officers are represented by unions. Those unions have spent 20 years bargaining for lack of accountability to protect, in their minds, their members. This means police officers have the right to huddle and discuss their stories before speaking to prosecutors. It means many other things.  But importantly, whenever any officer stands trial, the jury is instructed, per Chief Justice Rehnquist, to not use the benefit of 20/20 hindsight in judging their actions, but only what a reasonable, that is, terrified person, would do at the moment. Master Sergeant: "We have an entire job in the US military to validate whether or not we killed someone the right way." Owen Muir, M.D.: The court system is what's supposed to do that for police officers. But it doesn't; it just says, eh, it's okay. Master Sergeant: "That's an actual thing; we have entire organizational structures dedicated to the legality of murder." Owen Muir, M.D.: Killing black or brown people in America, if you're a police officer, has literally never been ruled against the law. Ever. Master Sergeant: "To not call it murder, to call it, to call it killing combatants, that's what a JAG does. Overseas, when they're deployed, they tell you whether or not you can kill this person. And sometimes, even though we can kill someone, we don't because they have a much higher value as an intelligence asset. Or for any number of other reasons. Or they're not actively shooting at us when we go get them. That happens a ton. Because sometimes, when you see 20 or 30 goons show up outside your house, breach your door with a shotgun round, rush in, and then point all their guns at you, you won't fight back. And then, okay, well, he's not shooting back at us, so we're going to take him in, and then... " Owen Muir, M.D.: You don't get to kill someone. In the U. S. military. Deployed in the field. In Afghanistan. Even if someone's a terrorist, if they're not pointing a gun at you and about to pull the goddamn trigger. “Cause one of the things I don't want to do is vilify police officers. And, and ...” Master Sergeant: "I mean, Owen, to be perfectly honest with you,  You may not want to vilify police officers, but the things I've seen police officers do in the past week while they know they're being recorded are actively the actions of villains." Owen Muir, M.D.: This hit me like a ton of bricks. This is not okay, but when people call for help, and the police arrive, they deal with a crisis. A lot of those crises involve people with mental illness, and police officers are being asked to do a thing that like is a whole medical specialty. Like, I'm a psychiatrist. It was 45 000 hours of training to learn how to calm people down when upset and have experiences we don't have access to. And, if you're called to the scene of a crisis, and someone's acting in a really strange and scary way, and you have a gun. You've been told to protect yourself, don't let yourself get hurt or let this person harm you, and you know nothing bad will happen to you if you pull that trigger. You're going to pull that trigger.  More often than not. And that's about a thousand times a year. You're about... God knows it doesn't even matter. The pe

    24 min
5
out of 5
29 Ratings

About

The Frontier Psychiatrists Substack has this companion podcast. Owen Scott Muir, M.D. is a writer, physician, scientist, and podcaster, bringing content about healthcare that is personal, weird, and less boring than most of the things you’ve heard. Subscribe at https://thefrontierpsychiatrists.substack.com/ thefrontierpsychiatrists.substack.com

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