Couch in Crisis

I just attended the 40th year reunion of my medical school class at Yale. As is common at these 5-year reunions, we compare our careers and the progress of medicine, although this time more of the focus seemed to be on our personal lives and our new Medicare cards.

I teach doctors and nurses how to assess, treat, and prevent delirium-an acute confusional disorder caused by multiple medical problems that mimics mental illness-but is actually a medical emergency.

John Ioannidis, MD, of Stanford University has published a paper with wide implications for medicine and also for psychiatry. He finds that many influential studies have made exaggerated claims purporting to find connections between biomarkers and medical illness.

I just received a very important email from Dr Dayle Jones who chairs the DSM-5 Task Force of the American Counseling Association (ACA). The ACA has provided a much needed wake-up call for the American Psychiatric Association.

A charismatic psychiatrist, Patrick McGorry has recently gained heroic status. First he was chosen to be Australia's Man Of The Year. Now, he has convinced the Australian government to spend more than $400 million over 5 years to fund his plan for a nationwide system of Early Psychosis Prevention and Intervention Centres.

Physicians are required to fill the compartment of their neuro-crania with much in the way of thought content. Many years later, they may find the surplus of that content resurfacing.

A large and comprehensive study recently performed in Korea has produced a surprising and disturbing result. The rate of autism is reported to be an astounding 1 in 38...

By now, insured Americans are familiar with the routine “cost-saving” measures created and implemented by insurance companies. What is probably not known to most people, however, are the routine oversight procedures that intrude on patient care, aggravate “providers,” and consume untold amounts of time.

Attention Deficit Disorder is now two or three times more common than it was just twenty years ago. A recent study reported that a whopping 10% of kids in the general population would qualify for the diagnosis. There has also been an incredible explosion in the use of medication in treating it.

Psychiatry is a wonderful specialty. We have highly effective medication and psychotherapy tools. Forty years of accumulated clinical research have given us a pretty clear idea of optimal treatment guidelines. With an accurate diagnosis and an appropriate treatment, most of our patients benefit greatly and many recover completely.

Osama Bin Laden is dead. 9/11 lives on. The sudden annihilation of the man responsible for that cruel and ultimately defining act brought me joy, and rekindled a sense of pride in our country and its capabilities.

The proposal to include "coercive paraphilia" as an official diagnosis in the main body of DSM-5 has been rejected. This sends an important message to everyone involved in approving psychiatric commitment under Sexually Violent Predator (SVP) statutes.

In addition to receiving birthday cards, on this birthday, one of our bloggers, Dr. Moffic, decided to send out a card to all those he loved. It is being reprinted here. "If you are what you love, There is no longer reason to be most modest, so step aside Muhammad Ali, for I Am The Greatest!"

What should clinicians do if they realize that they don’t like a particular patient who has come to them for help

Can the death of a terrorist be something to celebrate? Should it be? What can this tell us about ourselves? What is the "proper" reaction?

Rape is always a heinous, ugly, violent, and cruel crime. But the violence and cruelty that are part of all rapes should not be confused with the specifically motivated violence and cruelty that distinguish sexual sadism...

When my clinic manager told me that prison may be the best place to practice psychiatry nowadays, I didn’t believe him. After all, prisons often seem like a world apart, often in isolated rural areas or in windowless, nondescript urban buildings.

The personality proposals are certainly not the most dangerous part of DSM-5-but they do win the prize for being absolutely the silliest. They offer a riot of impossibly intricate detail with a level of complexity that could never be of any use in any real world setting.

Whenever a suicide happens in the New Asylums, a palpable, muted dread descends over the institution. It stays there in full force for weeks and months afterwards, sometimes longer. After that, it is added as another sedimentary layer to the strata and culture of the particular institution. Before things get too deeply buried, it is important to excavate.

II would have to wait until the next day, when K’s internal flames of resistance had died down, to learn why he had burned so fiercely. When we finally sat across from one another, his embers still glowed, and I learned that the source of his combustion had been the classic lose-lose scenario.

Had the National Rifle Association had its way and Bill 432 had been voted into law in Florida, physicians would have been prohibited from asking their patients whether they have access to firearms.

On April 1, a secret source let me in on a special addition to the new “Obamacare” healthcare reform law, which just had its 1-year anniversary. It will be released by the new Convocation speaker at the upcoming annual American Psychiatric Association (APA) meeting in May.

The Alliance for Human Research Protection is attempting to draft me as an unwilling soldier in its dangerous campaign to discredit psychiatry and to discourage psychiatric patients from staying in treatment and taking medication.

Addressing a few subjects that may have the potential to create a more insidious and enduring form of misrepresentation ... namely, the implications that psychiatrists must now “play the game,” and resign themselves to a bleak future of harried pill dispensing. 

The New York Times of February 14 carries the disturbing news of an alarming increase in deaths from accidental overdose among our active duty military personnel and our war veterans.

Watson, as many will know, is not necessarily the name of a human, though the Watson of DNA fame may come to mind. Rather, in this context I am referring to IBM's artificial intelligence computer system.

Pascal’s “Wager” uses “reason” to conclude that even though the existence of God cannot be determined, one should nevertheless “wager” as though God exists, because one has everything to gain, and nothing to lose.

I recently shared a research article on “no-suicide contracts” with a colleague who is very knowledgeable about suicide. That article concluded--as virtually all the previous literature had-that use of suicide prevention contracts (SPC) remains a questionable clinical practice intervention.

Ray Moynihan (who previously gave us the invaluable book "Selling Sickness: How Drug Companies are Turning us All Into Patients") has published a new expose titled "Sex, Lies, and Pharmaceuticals."

A reporter asked, "Can you do psychotherapy in a cage"? What immediately came to mind was the sociopathic psychiatrist Hannibal Lecter in the movie Silence of the Lambs.