“How far did you go in school?”

This is a question that I ask every new patient as a matter of course.

Granted, I have gotten some very odd answers, including hearing from a very successful businessman who only finished the seventh grade, or a very psychotic person who has a double master’s degree. Not implausible, but certainly not expected or the mainstream answer from the majority of my patients.

Now, leaving the children aside, most of whom are of course still actively engaged in academic pursuits, what is one of the most common answers to that question that I hear day in and day out?

I’ll give you a minute. Discuss, select a spokesperson for your group, and be prepared to show your work.

The answer is, “I finished.”

Now, if you were me, and you heard that, what would you think?

Depends on your frame of reference, personal experience, your own educational level and your expectations or preconceived notions about the person sitting in front of you. Yes? Do you agree?

The majority of folk who give me that answer, “I finished”, mean that they graduated high school. We could even split that hair further and talk about who got a regular academic diploma, who was on a technical track, or got a certificate of attendance, but that’s not important for this particular post. Fodder for another day.

“I finished.”

Often said with pride, sometimes with hesitation, and sometimes even with a little fear and trepidation.

We often read in our news outlets or see on television, especially in an election year, those who say that the common core is the ticket, others that say we are not setting the bar high enough, and still others who want to abolish the Department of Education all together. I think we all know in our hearts and heads, and can agree, that education, REAL education that can be put to good use in REAL life, is key to longterm success. Many of us know this. We have lived it, studying for years if not decades to learn a trade or skill or profession that will allow us to provide for ourselves, our families, and be active, vibrant members of our communities.

It bothers me, a lot, that many of my patients look towards the age of eighteen and the high school diploma that may come with it as being the pinnacle of their educational experience. Once they are emancipated from their home, and once they walk across that stage and flip their tassel from one side to the other, they really do believe that their education is over. They are not obligated to learn another thing. I believe that they believe that.

How sad to think that before you are even old enough to drink alcohol that you have essentially been taught that you do not have to be taught anymore. That you feel that there is nothing more that really entices you to read, listen, explore, or get your hands dirty in that way that helps you learn something  real that sticks with you far beyond a standardized test.

Life is all about learning. Learning something new every single day that we live. Trying new ideas on for size to see if they fit, and tossing them for others if they don’t. Visiting new places, having new adventures, reading new books, listening to new music, learning a new language, meeting new people who disagree with us, thinking outside the box that we have put the lid on, taped securely shut and put up on the shelf to (not so proudly) display the rest of our lives.

Life is about living, not just existing.

If we convince ourselves otherwise, we are shortchanged and hamstrung, limited and hobbled.

The second you finish learning and experiencing and growing should be the second that you draw your last breath. Who knows, we may even go on learning and experiencing past that point too.

The second you finish learning is the second that you become stagnant.

The second you stop learning, the day you say you have finished, is the day you will die.

There will be time for dying. That time will come for all of us.

For now, living, really living, is the thing that we should strive for.

(Feel free to comment on this post and share your feelings with me and others by visiting me on Facebook (Gregory Smith) or Twitter (@GregSmithMD). I look forward to your thoughts.)

Inside Out. A Mini-Review.

At the request of my fellow mental health partner-in-crime, Claire, I’m writing this mini-review of Inside Out. It happens to be a brief response to the review written by Maria Yang MD as well. Read her thoughts here:

First and foremost, I enthusiastically recommend the film. Pixar is masterful in the way they blend the technical, the artistic, and the ability to tell a good story, and this movie is no exception. It’s loads of fun for kids and adults. Be forewarned, though. I heard a few sniffles from both groups, including a few that seemed to be coming from me!

First off, I agree that the overarching theme of the film is that sadness should be embraced as a change agent. A positive one which moves a child and a family forward if it is allowed to run its course and interact with other emotions in a healthy way, not banished to a small circle of influence. 

To paraphrase Fred, Scrooge’s nephew in one of my favorite movies of all time: “And therefore, uncle, though (sadness) has never put a scrap of gold or silver in my pocket, I believe that it has done me good, and will do me good; and I say, God bless it! 

I too loved the way memories, thoughts, feelings, and interactions were all made vividly real, using physical objects, subtle changes in vibrant colors, and movement. I loved the various islands and the interactions, memories, and bonds they memorialized. 

I disagree somewhat with Dr. Yang about the fundamentals of sadness. To me, the fact that she was blue, lumpy, lethargic and unmotivated was perfect. The fact that she was dragged around was perfect. The gender issue is irrelevant to me. 

My patients tell me that sadness often drags THEM down, keeping them on the couch, chaining them to the house, putting them in a state of constant paralytic stupor. Sadness is not dragged around by Joy. Joy is the one banished to the small circle in the other room while Sadness drags us back to the couch. 

I loved the “window on the world” effect of looking out at what was happening. It was almost like we were watching a very colorful Starship Enterprise bridge populated by Kirk (I’ll let you guess which emotion he is!), and his crew. Yes, I’m showing my age, and I don’t care. 

As to the interplay between emotions, behaviors and thoughts? I agree completely with Dr. Yang’s summary of this, as it fits my workaday world with patients perfectly: “I believe that they are ulti­mately all related and each can have pri­macy, depend­ing on the cir­cum­stances.”

I firmly believe that we need to learn more about ourselves by learning about how we feel. I for one tend to overthink things, to obsess about things that I cannot change or that I should not spend another moment of time worrying about. But, alas, worry I do, because I am human.

I have found that if I am in the moment, embracing the emotion that is “in charge of the console” at that time (even if it happens to be sadness), that I am much happier. My head is clearer. My heart is more joyful. I can learn and feel and love and share and give back. 

If I allow sadness or fear or jealousy or anger or ambivalence or grief or any of these to control me all the time, I am shortchanging myself. If I allow ALL of these emotions and feelings and states of mind to have their turn pushing buttons and throwing switches, working as a team, I am a much more healthy, happy human being. 

Inside Out does not simply tell us these things. It shows us, with soft, fluidly changing colors, wide expanses of space in our minds, islands of safety and bonding and security, and emotions that make us human. 

Most of all, and most importantly, it shows us quite clearly that if we allow our emotions full expression and do not run from any of them, that we will continue to grow, thrive, love, and live well for the rest of our lives. 

Inside Out. 


See it. 


He walked towards those of us who were at least fifty people back in the TSA line, opened up the mesh strap barricade, and with a slight repetitive flick of his hand waved us toward a newly created line to the left. 

When I got to him, as he was verifying my documents, I thanked him for the small courtesy he had shown several of us. 

“No problem, sir,” he said, with just the faintest hint of a smile. “Have a very nice trip and rest of your day.”

“Looks like the usual early morning wait for screening in Atlanta,” the young man behind me in line said. 

A stocky, jovial-looking fellow in khakis and a blue and white striped polo, he was obviously traveling light. Not much to put in the gray tray but shoes and belt, wallet and phone. 

“Yes, ” I answered, “but they seem to be moving us along pretty well.”

We got to the steel rollers of the conveyor, I deposited everything per protocol, and inched everything forward, waiting for the mashup in front. 

“I can push that forward for you, sir,” he said, flashing me a big smile. 

I smiled back, saying thank you. Didn’t need to say anything more.  I turned toward the electronic screener and walked through. 

I handed her the two bottles of water and my debit card, ready to check out. 

“Why, good morning, Mister Gregory, and how are you this morning?”

“Can I interest you in some gum, too? Gum is always good, you know.”

I smiled broadly at her, declined the gum and the bag she offered for my drinks, and took the card and receipt back. 

“I love that bright smile of yours, Mister Gregory, I really do.”

After which, of course, I smiled even more. 

“You continue to have a blessed day.”

“Yes, ma’am, you too.”

I’m a middle-aged white male.

How many of these people do you think were black? 

You’re correct, and I commend you, if your answer was…

…it doesn’t matter. 

I’m going to New Mexico to feel the cool mountain air on my skin, the sun on my face, and to thank God for my family, friends, love, laughter, and life. 

I hope you all continue to have a blessed day.

Connecting the Shots

I don’t understand it. Do you?

I’ve spent my entire professional career, over three decades, trying very hard to understand people. To listen to their concerns. To hear their fears. To share their joys and accomplishments. To listen to their stories. 

I like most of my patients, very much. I love listening to their narratives. I love the fact that they trust me enough to share intimate details of their lives. 

Many times they ask me, “Have you ever heard anything like this before?” “Have you ever seen anybody as sick or crazy as me?” “Does this shock you?”

I just smile and reassure them that there is very little in this world that shocks me any more. I’ve heard it all, as many psychiatrists and other physicians have. It’s part of the toil and heavy responsibility and awesome privilege of this vocation we’ve chosen.   

One thing, though, continues to shake me to my very core. 

I don’t understand it. 

We humans take it upon ourselves to judge, hate, and kill each other.

The catastrophic shooting in Charleston, SC, a city I love and plan to visit again very soon, is just one in an ever-lengthening string of blatantly heinous crimes committed by individuals who take it upon themselves, for what ever reason, to decide the fate of one, two, a dozen, hundreds, or even thousands of innocent people. 

It hurts me personally, as I know it does you. It hurts me to know that I have spent years trying to help people, to make the world just a tiny bit better than it was when I got here, only to see that someone with a grudge and a gun can swiftly snuff out lives, hopes, and dreams. 

It hurts me as a healer. It hurts me as a man. It hurts me as a human being. 

This twenty one year old killer will be caught. We’ll hear many many details of his life, his story, his motivations. Many will mourn. Many will pontificate. Many will try to analyze. Many will use this event to further fan the flames of a destructive fire that will not die in this country. 

Will we ever learn? 

When evil incarnate can walk about unchallenged even in the Holy City, a lovely, serene, genteel place, and rip the fabric of civility and harmony like the temple curtain, can we dare to hope that we’ll ever get past our flawed nature and survive?

May those whose lives have been forever changed in Charleston and countless places like it find the peace that they, that we as a human race, deserve. 


She was in her eighties, but after speaking with her and her husband for only a few minutes I knew she had a frustrated twenty-five year old soul. 

“I’ve been depressed,” she admitted, almost apologetically. “I just don’t feel right. ”

It was a story I’ve heard a thousand times. 

He lives in an easy familiarity with hearth and home, yard and garden.

She longs for travel, the open road, activity anywhere but here. 

He turns his tanned, weathered, wind swept face to the sun, and is content. 

She dreams a young girl’s dreams of the stars, and is not. 

Both are still sharp, intact, cognizant of the march of time but nonconformists as only sweet, fabulously feisty eighty year olds can be. 

“I think some of it is the medicine,” she says. He agrees. 

So do I. 

In an octogenarian, it’s always at least partially the medicine. 

“Bring me the updated medication list from home,” I said. Of course, it was sitting on the kitchen table. “I think I know how we can help you feel better.”

She smiled, hopeful. 

He smiled, relieved.

Because he loves her, you see. 

He looked into my eyes, smiled a genuine sun splashed smile, gripped my hand, and shook it. 

“Thank you, doctor. Thank you.”

Some days, my patients give me a marvelous gift. 

They help me rediscover my purpose. 

I give them what little I can. 

They give me the gift of now. 


Jim Nightshade.

A solitary three foot tall blue heron painstakingly plods softly at water’s edge, then moves jerkily onto the bank. 

Mallards swim, no, glide over the green water, then hop out and chase and waddle and scoot and slip back in the pond.

Eighty four on the way to one hundred. Is that the temp I’m musing over or the depressed geriatric patient I just saw? 

Hot, flashing sparkles on the gently rippling lake. 

Edamame on my tongue. Hot pepper. 

A nap would be nice, but there’s no time.

There’s no time.