Couch in Crisis

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.

Learning to talk openly with patients about their suicidal ruminations poses more of an emotional than intellectual challenge.

Ideology is much less important than common sense solutions. The mentally ill have many unmet needs and suffer from great and undeserved coercion.

It is hard for mental health professionals to discuss completed suicides. Legal fears, confidentiality concerns, shame, and stigma are formidable obstacles. But talk we must, for talking-and listening-is a key to prevention and treatment.

An exchange that contributes in some small way to greater interaction and synergy among all of us who are trying to do our part to relieve emotional and mental suffering.

We avoid a basic aspect of human existence-namely, we are all a little lost and not knowing, and we had better accept this. In reminding our patients that the worst fate in life is not to suffer-but to suffer alone-we also remind ourselves.

Behavioral problems “masquerade” as physical symptoms. The time has come to treat the whole patient and to make psychiatry part and parcel of primary care.

It is the opinion of this psychiatrist that overtesting and overtreating is promoted and protected by the enormous economic and political power of the medical industrial complex. Here's just a beginning list of what needs to be done.

When the diagnosis of ADHD is clear, treatment can be successful, and education and supportive psychotherapy helpful. However, complications are common.

In the opinion of this psychiatrist, it is long past time to use the Internet to inform and empower health care consumers and reduce the monopoly pricing power of suppliers.

There is a subtle reluctance to admit that, at least in the field of medicine, the doctor knows more than the patient and is the expert in the area in which the patient is having trouble.

We have the target protein for Alzheimer, the antibody to knock out the protein, and the imaging test locating the protein in the brain, but there still remains one problem . . . who should receive the antibody?

This blog address the multidisciplinary approach to mental health care.

Dr Osheroff played a significant role for psychiatric practice in the 1980s. For many, his situation personified the changes that swept psychiatry at that critical juncture.

For now, it is encouraging to know that psychiatrists remember that they, too, are physicians first who can tap into their medical training to provide comprehensive patient care.

This letter is a plea to the leadership of the APA to develop flexible, user-friendly guidelines for criteria being implemented in the new CPT Evaluation and Management codes.

"I don’t want to climb any more cliffs. I’m looking for a slow job in a small town on the prairie," says the author in this work of fiction.

At the recent annual APA meeting, Dr Abraham Halpern was posthumously honored for the second annual Humanitarian Award by the American Association for Social Psychiatry. He was honored for his contributions to ethics, forensics, and advocacy of social issues.

To understand the psychodynamics of the dissociative fugue, Dr Michael Sperber analyzes some of the characters in a collection of interrelated vignettes set in small town America.

As most mental health professionals know by now, psychiatry's D-Day is rapidly approaching. DSM-5 addresses diagnostic categories, but there has never been an official treatment manual to complement the diagnostic one.

The art of living is the ability to use life’s inevitable traumas in some constructive fashion. This occurs on an odyssey that the resilient take that could be termed “the Journey of the Traumatized Hero.”

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.

Money should not be wasted on futile preventive programs to detect mental health problems that don't yet exist. Instead, resources should be invested where there is desperate need-to properly treat and decently house psychiatric patients who are now shamefully neglected.

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.