Couch in Crisis

It is yet unclear whether the overwhelming shock of Newtown will galvanize action not only to prevent future mass murderers, but also to finally reduce the public health and mental health risks of more chronic, common, and routine gun violence in America.

The discovery of an unknown family member can bring about joy or grief, and raise many clinical questions about the psychodynamics that are at play within families.

About a year ago, I wrote the blog “Are Dogs Man's Best Therapist?” To my surprise, it turned out to be a very popular one. Since then, dogs continue to be in the news for their therapeutic effect, including being brought to Newtown right after the mass murder there.

Crucial changes occurred that will greatly influence the organization of services, reimbursement, and diagnosis. It even ended in an exclamation point, as the tragedy in Newtown, Connecticut punctuated the need for improved mental healthcare services.

What we know for sure is that for all the young children and adults who were killed in Newtown, their world ended a week ago. Soon after the tragedy, one of the fathers of a child killed tearfully pleaded for society to learn from what happened in order to prevent future mass murders. Here, recommendations from a psychiatrist.

Patients with major depression or bipolar depression have a 20- to 26-fold increase of mortality rate over the general population. Suicidal behavior can be quite complex as well deadly. It should go without saying that psychotherapy is usually necessary in treating patients who have suicidal ideation or who have demonstrated such tendencies or actions. Frequently, it may be combined with medication and sometimes it is the treatment of choice without medication.

A recent article in the New York Times reports that doctors are prescribing stimulant drugs to compensate for the bad schools their child patients have to attend. Rates of ADHD have tripled in the last 15 years-precisely because many kids are being diagnosed with fake ADHD to make them eligible for medications and/or extra school services.

James Dao reports in the New York Times that the military is considering 2 steps to reduce its startling rate of active duty suicides-which is approaching an unacceptable one suicide every day. Both measures are completely sensible, but neither goes nearly far enough.

Improving our kids performance in school won't come from some vague, quixotic psychological fix. It requires they have better lives and better schools and that means us becoming a fairer society.

With understandable urgency, Secretary of Defense Leon Panetta has made suicide one of his top priorities, instructing commanders at all levels to feel acutely accountable for it. The numbers are startling. On average 1 active duty soldier is killing himself each day--twice the number of combat deaths and twice the civilian rate.

R.I.P. Rest Inspiring Psychiatrists. I am grateful for having known you.

Abortion is not a pretty subject. An embryo or fetus, while not a fully developed person, has the potential to become one. No one is “pro-abortion.” At the same time, there are circumstances under which a girl or woman feels strongly that her pregnancy is untenable-that she is too young, too poor, too burdened, too ill to properly mother a child. Women have abortions because they take motherhood seriously.

Seventy percent of antidepressants are prescribed by primary care doctors with little training in their proper use, under intense pressure from Big Pharma, drug salespeople, and misled patients, after rushed 7-minute appointments and subject to no systematic auditing. The cash-strapped FDA is beholden to industry for funding. And it gets worse.

Psychiatry has much in common with dentistry. After all, long ago psychiatry threw its lot in with the rest of medicine-that is, general medicine, specialty medicine, and surgery.

The shooting in Colorado is obviously a tragedy for the victims and their families which will never be forgotten by those close to anyone touched by this event. It will cause painful grieving among the families and friends of those who lost their lives.

Apathy is our enemy. Pain, paradoxically, is our ally because it is one of the most powerful fuels we have to impel us to a different and better tomorrow.

Ethics in the field of mental health is a concern for every psychiatrist, but what happens when past patients reenter a retired clinician's life in a personal setting?

Our current diagnostic system is based more on subjective clinical judgments and less biological psychiatry. There is not one way to develop symptoms of schizophrenia or bipolar disorder or autistim or OCD.

Psychiatrists, physicians, and mental health professionals are often asked to treat patients facing issues of sexual orientation and gender identity. Here are quick Tips for trans-inclusion of LGBTs.

Grief is the psychological, behavioral, social and physical reaction to a loss that is closely tied to a person’s commitment to heal.

Retirement requires psychological preparation. The planning and anticipation in itself can sometimes bring even more happiness.

In light of our problems and uncertainties about the state of current psychiatry, or perhaps because of them, what might describe good psychiatry? Following are some suggestions for what we, as psychiatrists, can do.

The mental health toll of any form of discrimination is great.

In our current age of increasingly biological psychiatry, psychiatrists seem to be paying less and less attention to the humanities, even as internists and surgeons are paying more attention.

If claims in the non-professional media can be believed, there is a “raging epidemic of mental illness” in the US, if not world-wide-and, in one version of this narrative, psychiatric treatment itself is identified as the culprit.

What are the psychological aspects of “going green”? How should we address what some call climate instability and global heating?

In many climates, a cold February is relieved a bit by the Super Bowl and then by Valentine’s Day-a symbol of hope for falling in love, sometimes suddenly and unexpectedly.

In today’s world, we are witnessing a de-emphasis and depersonalization of how the bereaved experience the death of a loved one. In fact, the occasion of death is frequently referred to as a “celebration,” despite the pain and suffering that can occur. Death is not an occasion for a celebration. Death is a time for mourning by family and friends. Death is a loss-not only to the deceased, who lost everything, but to all those who care about the deceased.

When we work with patients whose experiences don't align with our expectations, we must be careful not to dismiss those experiences simply because they clash with the overriding psychiatric paradigm.

Maybe the “Occupy Wall Street” movement suggests a different kind of protest for this year’s APA meeting. What about “Occupy Medicine” for us psychiatrists?