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My Ingenious Grifter

~ Frank ~ Leave a comment

This Thanksgiving there was not enough room at the “inn,” our oldest daughter’s house for my wife and I to stay on site as it were. We ended up in a massive guest hotel on a busy new byway in the Durham area that did not exist at all only a few years ago. In fact, the entire area we stayed in was all new to us and reflected the explosive growth in the corridors between Chapel Hill and Durham. and Durham and Raleigh, the area called the RTP or Research Triangle Park. However, nowadays, the abbreviation acronym “RTP” is now disconnected from the Park itself and means the huge area that is now growing together among the three cities.

The hotel we were installed in by our host daughter is massive, several stories tall, has every amenity imaginable from high tech to healthy exercise facilities, pools for the young grandkids, coffee shop for the caffeinating set, and of all things a super high end corporate steak house national chain, Ruth’s Chris Steakhouse where the price of a meal starts in the three-digit range. But all this courtesy of lots of discount plan points courtesy of daughter and we are paying thankfully a fraction of the daily inn price which would be obscene and a budget breaker for us.

Every morning when I travel, I arise very early leaving my wife to sleep in which is in keeping with her gender tied sleeping pattern. I can shower if need be, quietly, dress and go down to the breakfast area for a healthy morning meal, read all the area newspapers, catch up on my email, and talk with whomever I can engage who looks interesting. AT this hotel I found that the “chef” who cooks the omelets and waffles and such, knew off some past figures in the black independent community health center I had consulted at as the psychiatrist for this wonderful facility and group of providers. So he and I hit it off and we talked for nearly half an hour in between customers ordering omelets and such. It was great.

I sat at a row of s mall tables third from the window but out of the direct blinding morning sun’s rays, next to a very distinguished white-bearded, neatly dressed elderly man who had given me some of his personal history the morning before, that he was 84 and a past lifelong resident of the famous but nearly gone black district of Durham known as “Hayti,” pronounced ‘Hay-tie,’ not as the country. He had talked of its history the morning before and I knew he was indeed a former resident there from my own knowledge of the famous community wiped out partially two decades before by urban renewal and the cutting through of an important feeder highway that led to the RTP.

I had also noticed that my new elderly acquaintance would side in the row of tables always next to a black couple and talk in pointed asides to them. He would act as though he knew them and would call the middle ages and younger man “son” in an off-hand manner. Also when the wait staff or manager of the morning breakfast facility would come to be he would suddenly change his style of speaking and act confused and demented always looking toward the black couple in a dependent manner.

It took me a few cycles of this unusual behavior for me to catch on that something was playing out in front of me, that the elderly man was in no way related at all to the black couple he had latched onto in this subtle manner. I then thought that I caught him craftily wangling out of the couple their room number verbally but acting as though this was already known to him. As the couple made preparations to leave he quietly signaled to the waitperson that he needed a bill and signed the couple’s room to it. I was flabbergasted at what I had witnessed. It was so subtle and slick I had to run quickly the sequence of almost sleight of hand progressive steps the elderly man had effected. The black couple had no idea that they had been taken advantage of and were paying for his bill.

He saw me peering owlishly and knowingly at him at the end of all this and there was a moment of realization on his face toward me of “uh oh he knows,” but I nodded with a subtle acknowledgment signaling I was not going to rat him out. He put on his nice corduroy sport coat, grasped his cane and out he went behind the black couple to the outside. I watched carefully as he did not enter their car but took the city bus that came in a few minutes.

So this morning the old man and sat next to each other and he very obliquely acknowledged to me his entire act saying basically a poor old man has got to do what he can do. In a very sideways manner as I told him that 90% of all the explosive growth in common area among the 3 RTP cities of Raleigh Durham, and Chapel Hill was new to me since I had left the Duke teaching and private practice orbit over 20 years before, he listed dozens of hotels that he “visited” in cycles to grift his breakfasts. I was constantly thinking of safe ways to ask him more details about himself and gradually learned by elimination that he did not live in a nursing home, did have a daughter and her family who helped him but that he lived in some very modest solo circumstance he would not elaborate fully.

Also, this second day of conversing with him and observing his now apparent act, I realized that he would act mildly demented and deferential and dependent upon the black couple that was his foils for a family whenever the hotel staff would be doing their waitperson duties nearby. It was also very subtle, but effective and had the desired effect upon the hotel staff of inducing them to take care of him, never suspecting that they were being “had” in an ingenious manner. This second day, the old man knew I was fully on to him. By this time I had revealed to him that I was a psychiatrist. I had told him that I always tried to make friends and talk with anyone I met and that I had been reared in a family that taught me to be open to strangers, and that “everyone has a story worth learning.” That further reassured him so he continued his act, suspending it to converse with me when the hotel staff was not around. All the while he would include the black couple in the converse with remarks that sound innocent such as “isn’t ‘that right son?”

I bid him adieu this morning, still not knowing his name knowing I had been in the presence in the master of a craft designed for survival in this new world and realizing I had stumbled upon a man who was making his way in a way I felt I likely would not have been able to come up with were in his shoes.

Is Fortnite Addicting?

~ Frank ~ Leave a comment

WGN in Chicago had a news piece over the weekend that I heartily and snickeringly commend to the reader, “‘‘Addictive as cocaine’: Parents sue Fortnite creators.” Now we have the old saw and trope of a video game being addictive. Some parents in the Montreal Canada area, are now suing Epic Games with that assignation of guild in mind. (And I thought all Canadians were really polite!

I remember as the oldster in me likes to say, when very early games were judged addicting by the moralilsts, including Pong of all things. But back then in the early 1970’s that was basically all that was to be had and played with.

Pong one of the earliest video games

I supppose if you define gaming addiction by the amount of time its sucks out of the player, and how many real life tasks and roles it causes failure in, they can be addicting.

One of the comical things coming out of this story is that the law firm driving the suit, noted in a press release that the game released dopamine like cocaine does in the brains of players. As my son and all his friends, would say in mocking sarcasm, “Well YEAH!”So does watching pro football on tv, would say my spokesperson son of 19 years age and wisdom based on years of gaming. He noted that he does not gamble, do compulsive things, ignore his role in life, fall behind in his studies, waste away, etc.

He did have the final say on this latest tempest in a teacup. He and his friends over the weekend, decided the only way the game could be truly addictive like cocaine, was “if they sprinkled cocaine on the controller.”

Nuff’ said.

F

Naloxone for Chronic Pain

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My trusty Google search bot fleet turned up this recent article highlighting a recent piece on NPR (radio) that I had not heard or heard tell of as we say in the South since I work and cannot listen to it as much as I would wish. It concerned a trend in utilizing naloxone in treating chronic pain.

This is somewhat significant as naloxone is about as far away from using opioids to treat pain as you can get. Naloxone is used to treat addictions and simply cannot be viewed at all in the same pejorative light as opioids.

Naloxone, without boring the reader with a brainy, academic, overly pharmacologic explanation of the in’s and out’s of this area of “medication-assisted treatment” (MAT in the new parlance of addictionology), is a blocker of effects of opioids and helps to blunt the effects by which opioids and even alcohol induce and sustain addiction. It is both a generic (not a brand name, i.e., not expensive) drug and a brand name form drug, Vivitrol (super expensive and highly promoted by its parent manufacturer.

Naloxone has been around for decades. It has a well-established place in the pantheon of tools to treat addictions, along with, of course, the cognitive therapies and my sentimental favorite the 12 Step programs that I view as all-important in the journey of anyone in recovery.

As an aside, I will never forget my first patient with alcohol addiction as a naive, dumb, unschooled psychiatry resident over 45 years ago at Duke. He was not my then biased stereotype of a problem drinker, someone who had lost almost everything, came into the hospital inpatient service in alcohol withdrawal, etc. On the contrary, he was a professional, respected in his circles, accomplished, educated and showing almost none of the physical issues or stigmata of the ravages of alcoholism. He had relapsed. His treating Duke psychiatrist, my instructing attending was wise enough to ask this man to educate me about his disease. And this was in the days when moral opprobrium still reigned supreme toward alcoholism and addictions. the concept of addiction as a disease was just making headway into the lingua franca of our world then as the new enlightened way to view and approach addictions courtesy of two of then past giants in addictions, the recently late Dr. Herbert Kleber MD then of Columbia University Dept. of Psychiatry and UNC-Chapel Hill School of Medicine’s Dr. John Ewing, a giant in alcoholism research and treatment, founder of the Center for Alcohol Studies.

My patient above told me his ‘story.’ I had the sense to listen to him for as long as he wished to talk. He took me through his life account for well over an hour. I was astonished at how open he was with me about his failings, drinking, failures, and relapses. When I intimated that I would have to digest all that he had told me, he surprised me further. He asked me if I knew about A.A., Alcoholics Anonymous. I answered honestly that I knew very little. I recounted that I remembered my parents taking in geologists and mining engineers from my father’s international mining teams when I was a kid, who had been alcoholics and helping them get back on their feet. I said I only knew that my father had helped them go to AA and that it helped them but that was about the sum total of my knowledge.

My attending’s patient then proceeded to tell me of his years’ involvement with AA and gave me an introduction I would not forget. He helped me to see it as one of the most accepting, supportive organizations ever. I kept thinking to myself while he told me of AA, why weren’t most of our social organizations more like AA? Churches, fraternal orders, etc. I marveled at the trust he felt he was able to place in persons in AA.

However, what blew me away was one of the final points he left me with. He was a traveling professional, who worked in other professional centers somewhat regularly. He told me of how AA saved him from his core internal loneliness and depression that he struggled with. He spoke of his long past pattern of drinking to salve his loneliness in hotels away from home and family in the evenings after he had completed his consultations.

AA helped him to break that many year pattern by going after supper in hotels or restaurants to local AA meetings. He told me that he knew wherever he found himself, there would be an AA fellowship of persons in which he could find acceptance, support and positive booster inoculation against drinking. He described as the western world’s largest support community. I was flabbergasted as I grasped what he was conveying. And I never lost that sense of AA.

Back to naloxone. The article that set off all this in me, “In Tiny Doses, An Addiction Medication Moonlights As A Treatment For Chronic Pain,” from just days ago (Sept. 23, 2019) is well worth the reader’s attention.

One of the issues that might not strike the reader right off is that this long generic, out of patented brand name status, money-making status, has only modest research behind it to explain its now anecdotally reported effectiveness in unrelated pain syndromes. But reports are continuing to surface in some number and frequency that this medication is making perhaps a more and more solid case for more clinical investigation of it in pain control.

But, and it is a BIG but, it has not much potential as a MONEY MAKER. No drug company appears likely to pick it up and develop it as a pain modifying medication. The company marketing Vivitrol is not going to do so as documented in this NPR article.

So this possible more desirable medicine will be left to the backbench of interventions. It is not addictive in and of itself at all, like buprenorphine can be which is also used as an “MAT” medication in the treatment of opioid addiction.

This medication has little support for its use and ‘development.’ By development, I mean good clinical, nationally coordinated research that would establish its “place” in pain control clinical practice.

I think that generic medications such as this with a clearly very valuable social medical potential should be ‘adopted’ by the national research and clinical research arms that be. Monies to support and drive the clinical research that should be devoted to a medication such as this, ought to be easily devoted to its cause. A new mechanism of initiating, driving, funding and sustaining the R&D of such a lowly generic medication ought to exist. I would even propose a policy of supporting monetarily pharmaceutical companies to jointly share somehow monetarily in the sale of a naloxone category of medicine so that the use of naloxone or medicines like it, would not be a marginal effort but part of mainstream medical practice to benefit the huge cohort of pain patients who need an effective non-addicting medication intervention.

Just because a medication would never make BILLIONS for companies as the Oxycontins of this world have done, does not mean it should not be developed in a way that paves the way for its mainstream use and establishes its scientifically based modes of action in the mysterious world of pain.

A Manic Politician of History

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The ?Manic Political Long Family of Louisiana

From the pen of the human interest, humorous columnist Jim Bradshaw of the St. MaryNow.com website of Lousiana came the following hilarious piece regarding the Governor Earl Long, scion of the even later and more famous Huey Long, of “A Chicken in Every Pot” Depression Era fame: JIM BRADSHAW: WHEN EARL LONG’S MENTAL STATE MADE NEWS. I am always on the lookout for pieces that document the foibles of the famous cultural figures of our time, both for purposes of humor and for instructional examples to use with trainees in medicine and psychiatry in my work. This piece is worth the read. I would commend it to the reader for a pleasant interlude.

I have another purpose as usual. I had in decades past some older ancestors of my father’s family located in Louisian. Early on in my life in childhood and teen years I was exposed to one great aunt in that state on periodic visits to her home there. She was in 80’s by the time I came to hear family stories about the Civil War and other fascinating tales involving my father’s family’s long gone relatives. A few of those stories involved that branch of my father’s ancestors with the infamous Huey Long who ran for President and was one of the reactive voices of common people’s Populism during the Great Depression which my father and his own family lived through.

The tales I heard about “The Kingfish” as Huey Long came to be known, were incredible. I heard of demoagogic speeches that could spell bind huge outdoor audiences, hard drinking, a talent for non stop off the cuff jokes and so much energy that almost no one could keep up with him.

Gov. Huey Long at the Microphone

Then in later years as accounts of Earl Long’s own clearly “manic” spells came out, I began to wonder about the fast paced, non stop life that was Huey Long’s. In my residency and later practice years, I came be exposed to persons who were not fully manic but who clearly were non stop persons as I called them. I came to view as a distinct type, a diagnostic category in my own mind that was not recognized, and may never be, in the bible of psychiatry, the DSM, the Diagnostic Statistic Manual. These were persons who were always “on,” always hypomanic or just below that level of revved-up-ness. I once knew a salesman who could sell out his luxury foreign car dealership in three months and then spent the rest of his work year languishing at his NC beach house until the new model year of luxury cars came in. He would then return and then proceed to sell the stock out, drive out all the other salespersons and make the dealership owner most happy. He finally had a manic episode and confirmed my psychiatric musings about him. I met and knew over the years such figures who all worked inhumanly impossibly long hours, had non stop energy, could drink everyone under the table, were the dominating person in any room they graced, had insatiable sexual appetites, and were enormously successful. They were company heads, surgeons, attorneys and politicians of course. Most of them never evolved into full blown officially symptomatic manics, but many of their progeny did and that is how I came to know them and suspect the truth about them. Their genetic diathesis, posing as this constellation of lifelong energy and such, sometimes emerged in the full evolution of their hidden “bipolar” subclinical makeup.

And that is my take on the Longs, Huey was a closet hypomanic and Earl was a full blown hypomanic-manic person in times when all this was poorly understood and denied.

I have to not tease the reader with all this. I have reprinted Jim Bradshaw’s article on the late Earl Long below for your immediate gratification and your own judgment:

The Equally Spellbinding Gov. Earl Long

“Sixty years ago Louisiana and the nation watched with a combination of awe, incredulity, and amusement, a political episode that was bizarre even by the standards of Long-era Louisiana.
During the summer of 1959 newspaper front pages were filled daily with the tirades, tantrums, and shenanigans of Gov. Earl Long that caused him to twice be confined in mental institutions, and to briefly act as governor while he was an inmate in one of them.
The manic episodes, family members said, were the result of Long’s return to heavy drinking and taking an assortment of pills either to help him sleep or keep him awake. Long said that was humbug (in much saltier words).
He was always volatile and hot-headed, but reporters began to publicly hint at the governor’s overuse of alcohol as early as April, when the Associated Press reported the governor’s hijacking of a legislative budget hearing “with his bottle of Tichenor’s antiseptic on the table before him.”
But things really began to unravel in late May, when Long railed for more than an hour and a half and, the AP said, “poured out scathing criticism” on legislators and political enemies … “as he screamed into the House microphone in a stinging, stump-speaking style.” They noted that he drank from a glass filled with “what appeared to be grape juice” during the tirade.
Two days later, the governor’s wife, Blanche, announced that Long had been ordered to bed “for several days” and that he was suffering from exhaustion. One of the people helping to make that decision was Jesse Bankston, Louisiana’s director of hospitals, who thought Earl needed more than bed rest at the governor’s mansion.
He thought Long needed to be confined for psychiatric evaluation and that the confinement needed to be outside Louisiana, so that he could not use his powers as governor.
On Saturday, May 30, Earl was strapped to a gurney, put aboard an Air National Guard airplane, and flown to the John Sealy Hospital in Galveston. The doctors were told that Earl had agreed to be admitted. They soon found out differently. The AP reported that Long “refused to cooperate with hospital authorities.” The Galveston Daily News said his refusal included “a couple of violent episodes.”
He threatened his wife with federal kidnaping charges, and court-appointed lawyers in Texas filed papers claiming he was taken to Texas against his will. Long himself signed the legal papers, “Earl K. Long, gov. in exile by force and kidnaping.”
The hearing June 16 on his petition for release, according to United Press International, was punctuated by Long’s outbursts against, among others, “the horse doctors” who were overseeing his treatment. When the judge tried to quiet him, Long said he was just trying to help his lawyers prove he was sane.
Before the ruling came down in Texas, however, Long made a deal with Blanche and with his nephew Sen. Russell Long that he would consent to being moved to the Ochsner Foundation Hospital in New Orleans.
He was there one day before he reneged on his promise. He told Blanche he’d said he would go to Ochsner, but that he didn’t say how long he would stay. There was also a rumor, reported in the Alexandria Town Talk, that once the airplane was over Louisiana, Long planned to order the Louisiana National Guard pilot to take him to his farm in Winnfield, rather than New Orleans. It didn’t happen, but it sounds plausible.
When Earl reneged, Blanche had a friendly judge sign orders committing the governor to the Southeast State Mental Hospital in Mandeville. Once again, “a screaming, cursing Gov. Earl K. Long was hauled to a mental hospital.”
But this one was a state institution in Louisiana. While an inmate at Mandeville, Long called a meeting of the State Hospital Board and had its hand-picked members fire Bankston as state hospital director and appoint a new one, who, in turn, fired Dr. Charles Belcher, the superintendent of the hospital.
Belcher’s replacement saw no reason to continue to hold Long, nor did a friendly judge when the family tried to keep him confined.
The AP reported on June 26, “Gov. Earl K. Long swept out of a jammed courtroom a free man today — a complete victor over his family and state officials who committed him to a state mental hospital.
“Gov. Long immediately set up a temporary statehouse at the Great Southern Hotel … near Lake Pontchartrain. From room 221 in the hostelry, the governor is expected to drop the axe on political enemies.”
Which he did.
A collection of Jim Bradshaw’s columns, “Cajuns and Other Characters,” is now available from Pelican Publishing. You can contact him at jimbradshaw4321@gmail.com or P.O. Box 1121, Washington LA 70589.”

Book Review: The First Detective Postal Inspector

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Great read for history !https://amzn.to/2RbYs9M

To my readers: it is time for another book review which I hope to do on a regular basis every month or two. I will let the readers know that my selections of books are dictated strictly by my own reading interests and I hope they will be varied enough to interest at least a portion of my readers.

The book I have selected for this post, Inspector Oldfield and the Black Hand Society: America’s Original Gangsters and the U.S. Postal Detective who Brought Them to Justice highlighted above in the image of its book cover is one that I stumbled upon accidentally while searching in another subject area entirely this caught my eye and I knew I had to have it in hard copy form since I found that this was a volume I wish to keep in its physical form and not as an electronic, virtual book. Although the central character in this book, is named Mr. J. Frank Oldfield, he was not related to the famous racecar driver at the turn of the 20th century Mr. Barney Oldfield. This gentleman came from fairly humble roots and interestingly enough came to his profession and occupation as one of the country’s first investigative postal inspectors through the political patronage system where he grew up in the state of Pennsylvania and through his biological father who was somewhat of a political power in the area they grew up in. It makes for interesting reading as to how this process tended to work decades ago. Nowadays we would probably look on the influence peddling and political wrangling that help this gentleman come to into his appointment as a political inspector, as outright nepotism. What further makes the story engaging is that this gentleman aspired in a properly motivated professional manner to become a true postal inspector devoted to the service of protection of the public.

Overall the book traces his development into a supremely dogged, determined and very talented self-taught investigator who truly rivaled in his own way the sharpest investigative techniques of the day. As I’ve hinted in the sentence above, he was a remarkable individual because he really had no formal training in law enforcement, investigative techniques etc. He was truly self-taught. He also existed in an age in which there was no other national police force. He worked toward the end of the 1800s and early end to the 1900s which meant that the Federal Bureau of investigation or FBI, did not exist. Inspector Oldfield also operated before the era of prohibition and famous law enforcers such as Eliot Ness and others. The postal service was the largest national organization in the country outside of the national military organizations such as the US Army. This book also in its early chapters, gives a fascinating history and exposition of the development of the U.S. Postal Service from the eras of the Revolutionary war onward. This piece of history is no idle intellectual exercise as some of its most important early organizational features lent themselves to the ability of the U.S. Postal Service to be turned into a true investigative law enforcement mechanism as implemented by the central figure in this book inspector J Frank Oldfield.

Another fascinating piece of historical circumstance is that this Iinspector Oldfield was stationed in the Midwest out of the way of major crime centers, in central Ohio. It turns out that inspector Oldfield stumbled upon the phenomenon of criminal families in different locales, specifically and importantly located in different states. The historical account of how Inspector Oldfield discovered the existence of ties between criminal families in different states is nothing short of fascinating. This was not an over night discovery but a process that took many months and incredibly persistent mundane effort to sketch outI the existence of cooperation among criminal familiesI that had never been realized in this country before. The reader begins to discover that figures like Inspector Oldfield, and the US postal services inspector capabilities were the only law enforcement body capable of mounting investigations that crossed state lines.

Inspector Oldfield discovered odd use of the Postal Service in a small town outside Cincinnati Ohio. He was astute enough to focus his attention on this criminally appearing anomaly in which a family of Italian fruit vendors and distributors sent money overseas to Italian relatives and also so to other Italian families in other states notably Pennsylvania.

This led to his fateful discovery of the then unknown Black Hand Society, the forerunner in Italian – Sicilian organized crime that evolved in decades to come, especially during and after the Prohibition era to the Mafia, or La Cosa Nostra. As a bit of a spoiler I will reveal one of the fascinating elements of this story which was that at the time Inspector Oldfield discovered and mapped out the existence and structure of this new organized criminal organization, no national state or regional law enforcement body believed even in the concept of organized crime. It was felt that all crime was local and that criminals did not coordinate their efforts across state lines at all. So Inspector Oldfield was fighting against the prevailing notions in law enforcement about the magnitude of criminal activity that was evolving in young modern America.

The authors of this book did a masterful job of constructing the narrative. It reads like the best mystery novel as the plot line unfolds and one witnesses every step along the way of the incredible investigation. It is also extremely interesting as one realizes that the efforts of one man, tucked away in middle Ohio, discovers the existence of ethnic organized crime that served to form the institutions on a national level of law enforcement investigation, namely the Federal Bureau of Investigation under the redoubtable J Edgar Hoover. The authors also researched this book incredibly well. Their references and citations also furnish incredible material for the curious. The narrative of this book is completely supported by the research efforts of the authors. A telling example is that the authors even located a turn-of-the-century photograph of one of the original black hand Society criminal families who look incredibly ordinary like new immigrant workers.

All in all this is a diamond in the rough, a gym of a book regarding little-known history of the U.S. Postal Service, the evolution of its core of postal inspectors into top-flight investigators who paved the way for the decades long war against the Mafia by the U.S. Congress and the Federal Bureau of investigation in modern times.