René J. Muller, PhD

In periodic entries in his journal, the Columbia Mall shooter acknowledged having a “general hatred toward others.” He had insight into his deteriorating condition, as he felt himself slipping away from rationality and health.

In spite of a chronic mental illness (schizophrenia)and a psyche that increasingly blurred the boundaries between fantasy and reality, this lawyer and professor graduated from Vanderbilt with a perfect academic record.

What is transparent to one person may be opaque to another. It is clear to me that before symptoms can be used to make a valid psychiatric diagnosis the meaning and context of these symptoms must be taken into account. Many clinicians do not see it that way. Neither did the DSM-III and its subsequent editions.

Anger is an emotion that is familiar to everyone. An episode of anger may dissipate quickly and harmlessly or evolve into a murderous rage. Between the benign and malignant end points in this spectrum, a seething, chronic anger may come to dominate a person’s thinking, feeling, and behavior.

Considering that the brain is increasingly being credited with having a role in everything we think, feel, and do, it was probably just a matter of time before it was postulated that religious belief has a neural substrate.

Psychotic symptoms--delusions, hallucinations, paranoia, thought disorder--are mostly attributed now to aberrations in brain structure and function.

Many highly regarded clinicians have built careers working with patients they believe to have dissociative identity disorder (DID). Other distinguished practitioners consider DID to be a bogus diagnostic tag.

Dr Muller describes a case of a patient with a paranoid psychosis who clearly needs help, yet refuses treatment.

Rather than looking at the biological basis for depression, it may be more useful to look at the patient's worldview and how that may have primed them for depression. Examining events that took place in the patient's past lead to a solution to their current depression.

There is a range of meaning that underlies patients' violent acts against themselves. The usefulness of so-called "safety contracts" to actually predict suicidal behavior is questioned.

Known as "the cancer of mental illness," schizophrenia can core a life, robbing a previously well-functioning person of what made the person uniquely them.

Once the distortions are cleared away, most patients who come to the emergency room tell stories that seem to grow out of the problems they claim to have and the pain they claim to feel.

By the time I interviewed Robyn in the emergency room, her panic attack had all but passed. But this 21-year-old woman was still shaken and tearful. This was her first panic attack, and she did not know what hit her. She thought she was having a heart attack. She had a tight feeling in her chest, she was hyperventilating. Her fingers and feet were numb and tingling. She experienced what she called a "closing in feeling." Robyn thought she was going to die.

Dissociative identity disorder (DID), known as multiple personality disorder until renamed in the DSM-IV (American Psychiatric Association, 1994), is a controversial diagnosis.