Couch in Crisis

In psychiatry, it seems like our traditions are often ignored or discarded as being outdated. Do we not have some time-tested literature that is still relevant to our psychiatric times?

“Love and work are the cornerstones of our civilization.” This quote, rightly or wrongly attributed to Freud, simply and succinctly indicates the importance of the “Occupy Wall Street” movement.

A new CDC study based on a large survey of the general population reveals the following alarming results.

When I was a first-year resident, a revered supervisor of mine made the statement-half-facetiously-that, “In psychiatry, you can do biology in the morning and theology in the afternoon!”

A recent study concluded that depression is associated with a significantly increased risk of stroke morbidity and mortality.

A recent front page story by Shari Roan in the Los Angeles Times explores the heated controversy over the DSM-5 proposal to include a Disruptive Mood Dysregulation Disorder (DMDD) in DSM-5. I very much oppose the inclusion of this new "disorder."

The misdiagnosis of rape as a mental disorder has been a forensic disaster-allowing the widespread misuse of involuntary psychiatric hospitalization to facilitate a form of questionably constitutional preventive detention. Fortunately, there is now considerable hope that this sad episode will soon come to a much needed end.

I do not hear loud applause for our current antidepressant armamentarium. I believe I hear the sound of one hand clapping.

I have previously framed a series of questions inviting Professor McGorry to state clearly his current positions on: the accuracy and suitability of attempting to predict psychosis; the types of preventive interventions that he believes are indicated and those (perhaps antipsychotics) that clearly are not . . .

With all the justifiable concerns about our next DSM, I frankly have more concerns about treatment. After all, diagnosing is really most important as far as it leads to the necessary treatment to help the patient.

Mental health reform is one of the world’s “grand challenges.” Mental, neurological and substance-use (MNS) disorders constitute 13% of the global burden of disease, surpassing both cardiovascular disease and cancer.

In preparing DSM-IV, we worked hard to avoid causing confusion in forensic settings. Realizing that lawyers read documents in their own special way, we had a panel of forensic psychiatrists go over every word to reduce the risks that DSM IV could be misused in the courts.

The DSM-5 attempt to “dimensionalize” the diagnosis of personality disorder has worthy goals, but has suffered from grievously incompetent implementation.

The entire field of psychiatric epidemiology has a systematic bias that leads it to misleadingly report what are highly inflated rates of psychiatric disorder.

A newly appointed DSM-5 scientific review group is meant to “review the reviews”-but it is working in secret and so far appears to be a remarkably porous filter . . .DSM-5 has shown no capacity to self-monitor and self-correct. An outside review is sorely needed-and fortunately a ready mechanism is in place.

I just read a blog by Dr Dayle Jones that could have an important influence in the endgame effort to save DSM-5 from itself.

Although his plays are suffused with dynastic and generational issues, Shakespeare hardly wrote anything about grandparents per se.

It is our responsibility as psychiatrists to educate the media and the public in general.

A dark cloud surrounds the silver lining of having one psychiatrist in a position of almost unopposed influence . . .

Dear Mrs. -- You have asked me about the cause of your mood disorder, and whether it is due to a "chemical imbalance."

I never would have entered the DSM-5 controversy were it not for two of its proposals that risk furthering the already frightening overuse of antipsychotic medication, particularly in children and teenagers.

Many will recall “The Decade of the Brain,” when President George H.W. Bush declared that the 1990s would be dedicated to research on neuroscience. If there were landmark findings from that decade, I’m not sure what they were.

Polypharmacy has become so ubiquitous that more accidental overdoses are now caused by prescription drugs than by street drugs. The question naturally arises whether this almost routine use of multiple psychotropic medications make sense?

Martin Whiteley is an MP who represents Perth in the Australian parliament. He has been actively involved in mental health issues and succeeded in a crusade to curb what had been Perth's alarming overdiagnosis and overmedication of Attention Deficit Disorder (ADD).

President Obama announced that he would begin sending letters of condolence to the families of troops who kill themselves in combat zones. He noted that this was a decision that was made after a difficult and exhaustive review of the former policy.

Harvard University Psychology Professor Marc Hauser, who last year was found solely responsible for 8 counts of scientific misconduct following an internal investigation, has resigned from his tenured position at the university effective August 1, according to recent press reports.

Those of you who have been following the SVP controversy know that "Paraphilia NOS, nonconsent" (PNOS) is a fake diagnosis that is losing traction as justification for committing rapists to psychiatric hospitals.

The legend of the “chemical imbalance” should be consigned to the dust-bin of ill-informed and malicious caricatures.

During the past year, I have been involved as an expert witness for the defense in 14 SVP cases (tried in California, Washington, and Iowa). My role has been to clarify what is meant by the wording of the Paraphilia section in DSM-IV. And it certainly does badly need explaining.

There are not enough participating psychiatrists to accommodate all who would seek treatment if it were affordable. This is not a good situation.