Matthew B. Smith, M.D.

Matthew B. Smith, M.D. General adult psychiatry

General adult psychiatry, with additional experience in consultation-liaison, chronic pain, brain injury, adult attention deficit disorder, personality disorders, anxiety disorders, and mood disorders.

03/21/2022

Social and political tensions may not actually cause psychiatric problems, but they certainly influence the incidence and severity.

03/01/2022

Common clinical points regarding anger.
Anger is an emotion, a private subjective experience of feeling, not intrinsically connected to any thoughts or words or actions. It usually reflects a subjective experience of unfairness.
It is often connected with thoughts or fantasies that reflect a range of matters -- from fixing something, to asserting something, or speaking something, or actually harming something or somone. There may be an urge to take action. But such thoughts do not require that action be taken. And thoughts them selves are clearly not matters that impact the world, are distinct from actions. Thoughts or words or action are distinct from the emotion itself.
One can experience the emotion of anger, and accept it, without speaking or or taking action; or one can make use of the anger as motivation to speak or act. But if so, it is important to contemplate which words or actions are likely to be useful or productive, without immediately acting upon them. Delaying words or action to determine the best words or action, if any, is important.
There is no need to "expel" the anger with words or actions. One can endure the continuation of the subjective, private emotion of anger. One can be angry and control one's words and actions.
If this seems challenging, then consider that the particular issue inciting anger may be provoking a personal residue of other anger from other circumstances, which has been held in abeyance, but has needed some sort of resolution.
In short, experience and accept anger, consider what useful action may be taken on its basis, and accept that perhaps there is none, or that the choice is based on deliberation.
To try to not experience anger would be problematic, as it would be a rejection of one of the core components of being human, of one's self. It would also eliminate the important motivation of action against unfairness. And there is possible physiologic harm in trying to suppress anger, rather than accepting it and experiencing it, without the immediate "release" of words or actions.

01/29/2022

Happy Kazoo Day!
A day for kazoos and the people who love them.

09/06/2020

What is lost, in an intervew when conducted by phone or by video?
Virus precautions may require that face-to-face interviews be temporarily given up, but, psychiatrically there is no fully viable replacement.
A psychiatric interview, for assessment or treatment, requires that the psychiatrist experience the other person, not just acquire a list of symptom by patient report or history, and signs by verbal or visual observation of an electronic image.
More specifically, tone of voice cannot be fully accurately reproduced; prosody is similarly approximated or distorted. Facial expression is obviously absent by telephone, but is also not fully natural or authentic in electronic reproduction. Gestures, physical movements, unseeable by telephone, and largely unseeable by computer video.
Then there are he interferences of various electronic, home space and privacy problems, as well as the anticipation of them or interruptions by them.
A full rapport is not really possible without the subjective experience of a direct face-to-face encounter. There is a created interpersonal “reality,” much of which may be subliminal. It involves the mutual give and response to the evolving interpersonal experience, which includes the verbal, prosodic, visual, and “parlinguistic” aspects of of communication -- direct and real eye contact, expression and communication including give and take of body postures and gestures.
In my opinion, telpehone -- voice alone -- is inadequate. Computer video is viable, if understood as an incomplete substitute -- but perhaps only with patients that one has previously seen in person.

06/06/2020

Social distance costs, psychologically, even when necessary. Most significantly, the lack of direct face to face contact, and the reduction in physical touch, take a toll that is only partially handled by video and voice and writing.
Best self-management is recognition and acceptance of the emotions.

06/04/2020

We learn how a psychiatric assessment, a forteriori a psychiatric treatment session, requires the in-person interaction the the patient, although it can be “winged” with a video session.
Apparently there are those who believe that all relevant factors can be obtained from the patient’s words, prosody, and tone of voice. But they forget about the nonverbal gestures and movements; and most of all, they fofget about the intangible experience if the person and his or or state, whichcan be put into words only with great difficulty, but which can be axtremely important

06/04/2020

We learn how the psychiatric illness or strength of the nation’s chief executive influences the psychiatric illness or health of the citizens.

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