Ronald W. Pies, MD

If serotonin was once American psychiatry’s “high school crush,” the field now appears wedded to a more mature model of biological and psychosocial understanding.

Ronald Pies, MD reviews the second edition of Ansari and Osser’s overview of psychopharmacology.

May we forgive a murderer on behalf of his victims?

Critics of psychiatry claim there is an “epidemic” of mental illness in the US-and some argue this is a consequence of psychiatric treatment. But the best epidemiological evidence reveals no such epidemic in this country, rendering the iatrogenic “explanation” null and void.

There is a myth circulating in the blogosphere-usually among the most extreme critics of our profession-that there exists some monolithic entity called “Psychiatry” (with a capital “P”).

For many of us who went into psychiatry, relieving the patient’s suffering is not a business enterprise, but an ethical and spiritual calling.

A recent report that argues against descriptive diagnosis in medicine is historically ill-informed and medically naive, in the opinion of this psychiatrist.

What do physicians intend by the term “disease”? The recent IOM report on “systemic exertion intolerance disease” (formerly known as chronic fatigue syndrome) casts this question in a new light and has many practical implications for patients, physicians, and third-party payers.

Readers of Albert Rothenberg’s new book will come away greatly enriched by the author’s own lifelong, creative synthesis.

A commentary on civility and ethical standards in the aftermath of terrorist events in France.

“Distress” hardly captures the inner world of those with severe forms of psychotic illnesses. Terms like “agony,” “torment,” and “anguish” would be much closer to the mark, for many patients.

There are probably many social, economic, and familial forces at work in generating the trend toward public incivility, and it would be silly to blame the Internet for the riot in Keene.

The “story behind the story” is not the over-prescription of antidepressants-though it happens-but the under-availability of optimal treatment.

If you’ve never surfed the web for sites that critically examine psychiatry, I highly recommend it-though it’s not for the faint of heart.

A limited sampling presented here lends no support to Dr Thomas Szasz’s claim that 19th century physicians regarded the term “mental disease” as merely a figure of speech; on the contrary, several prominent physicians of this era recognized such conditions as both real and debilitating.

It is time for psychiatry’s critics to drop the conspiratorial narrative of the “chemical imbalance” and acknowledge psychiatry’s efforts at integrating biological and psychosocial insights.

The ethical status of suicide is not a question psychiatrists can ignore. After all, our duty to preserve and protect life is founded on moral values, even if they are so deeply embedded in our medical ethos that we no longer sense their moral underpinnings.

The physician’s knowledge is almost always fragmentary and incomplete--and often, “we see through a glass, darkly.” But we must not allow these limitations to deter us from diagnosing and treating our patients to the best of our ability.

A brief tribute.

While it is true that the intense grief of bereavement and major depressive disorder often share some features-for example, tearfulness, insomnia, low mood, and decreased appetite-there are many substantive differences.

The ethical aim of psychiatry is the relief of suffering and incapacity.

When critics of psychiatric diagnosis insist that terms like “schizophrenia” or “bipolar disorder” are inherently stigmatizing, they are unwittingly perpetuating the very prejudice they wish to end. It is time to shine a bright light on this self-fulfilling prophecy.

There are several reasons for taking the ketamine findings with a substantial grain of salt.

The issue of context and its relationship to disorderness extends well beyond panic attacks: it arises in nearly all psychiatric diagnoses not explicitly defined contextually.

Panic attacks are nearly always pathological and disordered states, even when they occur in an understandable context.

The DSM-5 will eliminate the bereavement exclusion in the diagnosis of major depressive disorder for 2 main reasons.

If we, as a people, continue to sacrifice genuine security for a false sense of freedom, we shall find ourselves in a nation neither secure nor free.

Is the expression “mental illness” merely a metaphor? If so, does that tell us something about the persons we identify as having a mental illness? To clinicians who deal with devastating psychiatric disorders every day-and to those afflicted with these conditions-these questions may seem like a lot of semantic nonsense.

Dr Thomas Szasz dies at 92.

Our exchanges be marked by basic respect and civility-and by a willingness to take personal responsibility for what we say and how we say it. Physicians ought to be in the vanguard of such an Internet reformation.