Couch in Crisis

Telehealth is here, and it’s here to stay. A telepsychiatrist gives a brief description of the setup from his home office.

In the eyes of many, the current societal approach to the treatment of psychiatric disorders cannot possibly be considered humane. More in this commentary.

The transition to telepsychiatry is great, but the benefits, many. In this humorous piece, it becomes clear to this clinician that telepsychiatry can be a viable, valuable, and timely addition to the psychiatric profession, despite minor mishaps in the first week.

If clinicians are to take anything from the Johannesburg debacle, it is that we must be even more mindful of distress and despair. Like Poe’s purloined letter, profound sorrow may lie in plain sight under one’s clinical gaze-but not yet “thought upon.”

The mental health community was given some much needed relief when the Obama Administration implemented the final rule be put in place from the 2008 Mental Health Parity and Addiction Equity Act. The new mandate will ensure that most health plans cover mental health and addiction services in the same way they treat other medical issues.

Apologies seem rare, as does asking for forgiveness, when it comes to Internet ethics and cyber-bullying. Given the “Wild West” nature of Internet communication-with no commonly accepted rules-what might be done? Is there a communication model that might work better? Yes there is, according to this psychiatrist.

Here are a few of this year's popular features on our website, in no particular order.

In the opinion of this psychiatrist, the point of the MOC test isn’t to measure competence, but to convey the impression that competence was measured. The point of the test is to say that a test was given-and nothing else. More in this commentary.

"The main problem here is not that past DSM leaders were derelict or purely political. The problem is that they now say that they would place science below pragmatism," according to this clinician.

According to the author, stimulant drugs that 20 years ago had annual revenues in the tens of millions now are a Pharma "cash cow" with sales that will soon hit $10 billion per year. How did this happen?

The controversy around marketing practices for ADHD.

As practicing physicians, we constantly ask ourselves when and where to alert patients to bad possibilities that may occur in the future. More in this installment of "Why Psychiatrist Are Physicians First," by Sharon Packer, MD.

We know so little about community grieving. What is normal and what is not? Perhaps the tragedy in Newtown needs a careful analysis over time.

Some serendipitous occurrences made me wonder (even as a rational psychiatrist) whether something spooky and supernatural had been transmitted to me by the shaman who conducted a "Mother Earth" ceremony. Here's what happened.

A range of psychiatrists are remembered-from pioneers in psychoanalysis to trance studies; from psychopharmacology to reality therapy; from the normality of homosexuality to the psychopathology of “brain fag” syndrome; from flowers to film; from childhood to old age; from everyday clinicians to courageous challengers of the status quo; and from student to expert.

A documentary film review that compels one to wonder if Szasz’s alleged suicide should be seen as a courageous adherence to the principles by which he lived or a symptom of a pathological avoidance of helplessness. Dr Szasz might reply that either way, it was his choice.

Sexual abuse is shockingly common in the US prison system. It has been reported that about 200,000 prisoners are victims of coercive sex each year. Most of those abused are psychiatric patients misplaced in prison.

Most New Yorkers were afraid to venture outdoors after the Twin Towers toppled, so a short term, part-time locums post opened upstate, an escape from the decaying metropolis and retreat to the country. What could go wrong in such an idyllic setting?

On the value of drawing from past experiences to establish a relationship with an elderly patient.

Psychiatrists have patients who need help and we have the tools to help them. Some of these tools are technical and specific (meds; CBT); but even these work best only in the context of a rich therapeutic relationship that is based on all that makes us human.

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.

If science is defined as some kind of systematic study of observed experience applied to hypotheses or theories, and then confirmation or refutation of those hypotheses or theories, followed by new hypotheses or theories that are further tested and refined by new observations – if this is the core of any scientific inquiry, I think that no objective observer can attribute the history of DSM-III, IV, and 5 to anything that approximates this process.

Army psychiatrist MAJ Nidal Hasan sought to get out of the service, but the Army, which had poured hundreds of thousands of dollars into his military and medical training, offered him no legal exit.

A dually trained family physician and psychiatrist wonders about his own relief when a patient misses his third clinic visit in a row.