Couch in Crisis

I would like to start off this blog with two stories that happened many years ago.

A large new study from Australia found that DSM-5 would cause a sky-rocketing 60% increase in the rate of alcohol use disorders.

Is it possible to “forgive” Jared Lee Loughner for what he is alleged to have done? Is it morally justifiable to do so? There are serious ethical problems with the notion that anyone other than the survivors of this horrific shooting can “forgive” the assailant.

Gary Greenberg, PhD is a psychotherapist, author, teacher, and historian of psychiatric diagnosis. His writings are characterized by penetrating insight, elegant wordsmithing, entertaining story telling, and a dig-deep, no-holds-barred search for underlying meaning.

There have been three positive developments. The rest of the DSM-5 news continues to be extremely worrisome, and time is running out.

Anyone who has written blogs or published articles online knows that the Internet is the new “Wild West,” so far as etiquette is concerned.

Sometimes, when I recommend an antidepressant, patients will ask if it will make them happy. No, I usually eventually answer. I try to gently and empathically point out that what we have are called antidepressants. They are not called happy pills for a good reason.

December 17, 2010 was a special day in the history of psychiatric diagnosis. Bob Spitzer retired after a remarkable 52 year career.

Consider your pearly whites. You probably take 'em for granted anyway. When was the last time you flossed?

Have you been following the recent dust-up in the anthropology world? It all started, as Nicholas Wade wrote, “…after a decision by the American Anthropological Association at its recent annual meeting to strip the word “science” from a statement of its long-range plan.”

The face of the woman sitting across from me begins to quiver, and my job as a psychiatrist is to keep my mouth shut. I knew when she came in and said her beloved Scottie of 15 years had died how big a loss that was.

We've just had Thanksgiving and I have been in a most thankful mood. I'm still feeling that way after returning to work--and even after an email from a colleague reminded me of one of the many problems facing our field.

Would you be surprised to find out that Freud is gaining a foothold in China? As psychoanalysis and related therapies are slipping in the USA, psychoanalysts from the US are beginning to train a cadre of interested clinicians in China.

Similar to some forms of PTSD, this disorder is prone to be severe because the stressor is of human/corporate design. Note: this diagnosis is not currently reimbursed by health insurance carriers.

I am a Registered Nurse of 37 years who has worked in hospice care and psychiatric emergency; I’ve worked as a med/surgical manager and (now) as an inpatient psychiatric nurse. Throughout it all, I most enjoy seeing a patient realize he/she is getting well; I also enjoy conducting small teaching groups to help the patient know how to stay well.

For some, creating art may be a displacement of issues and conflicts that we encounter in our work and personal lives. It can express things that can't be formulated in verbal content, as has been shown in art therapy with patients.

The most disturbing turbulence at the boundary between psychiatry and the law is the misuse of a makeshift psychiatric diagnosis to justify the involuntary, indefinite psychiatric commitment of rapists. This is a disguised form of preventive detention and an abuse of psychiatry.

Just imagine. If you are not a transgender individual, what must it feel like to always think, as far back as you may remember, that you should have the body of the opposite gender? That you were “born in the wrong body”.

The latest information released by the US Army reveals that last year American soldiers attempted suicide at the rate of about 5 /day. There were 160 successful suicides last year and during June the rate was 1/day. Military research has reported that one in 10 Iraq veterans may develop a severe case of PTSD.

It is easy to claim the presumed high ethical ground when one is not involved in the real life situation at hand. It is also easy to project and proclaim strong positions in order to cover our own inadequacies and anxiety.

Empathy is the ability to put yourself in someone else’s shoes and understand what they are feeling. This is something that psychiatrists try to do in our everyday work. Those of us who have worked in medical schools have struggled with the question of whether or not this is something that can be taught.

My medical school clinical preceptor asked me, during my first year, what specialties (at The University of Chicago, the attitude toward general practice was well represented by the dismissive references to ‘LMDs’-local medical doctors) I was considering.

Insurance restrictions sometimes make for strange bedfellows. My story begins with a phone call from a man about to lose his job. He said that he had been placed on probation and was about to be fired. He asked if he could see me. We met the following day.

There is a difference of opinion among psychiatrists whether it is time to restructure the APA to a “leaner and meaner” organization where activities and functions by necessity have to be cut back because of reduced income.

“I just threw him in the lake and expected him to die. . . My only regret is that he lived.”

Due to decreasing revenue, the APA Assembly has been forced to reduce its budget by $200,000 and and many of the APA Components have been eliminated or significantly changed.

It was great to learn that within the past month, the Obama Administration issued new rules that promise to improve insurance coverage of mental healthcare for more than 140 million people insured through their jobs.

When a soldier is killed while in the military service the President writes a condolence letter to the family. However, if a soldier is psychologically injured and then commits suicide, there is no Presidential letter of condolence.

I don’t know how many psychiatrists paid much attention to the climate-change conference in Copenhagen last month, but I came away convinced they need our help. Here’s why.

The debate within the medical profession over “conflicts of interest” (COIs) has often been shrill, and sometimes seems to be based on misunderstandings or myths about what COIs entail. In this psychiatrist’s view, it is helpful to step back from confident proclamations, acknowledge that the issues involved are complex, and aspire to some semblance of humility. Nobody has cornered the market on “the right way” to deal with COI in the realms of medical research, publication, and education.1 At the same time, as Alan Stone, MD, has noted (personal communication, August 27, 2009), ethical considerations lie at the heart of any debate on COI-in particular, the ancient dictum, “Do no harm.” Indeed, ethicist James M. DuBois has pointed out a direct connection between some types of COI and harm to the general public: “Mental health consumers are at risk when studies that involve questionable scientific and publication practices are translated into therapeutic practice.”1(p205)