Nebyou Belay, MD
Nebyou Belay is a practicing psychiatrist with twenty years of experience treating children, adolescents, and adults. He is affiliated with the Brown University Department of Psychiatry and practices at Rhode Island Hospital and Newport Hospital.
He writes about the practice of psychiatry itself: how diagnoses are made, how they're communicated to patients and families, and how psychiatric language is understood (and often misunderstood) in the wider culture. His work touches on the science and the limits of psychiatric assessment, the boundaries of what medication and diagnosis can realistically offer, and the growing overlap between clinical language and everyday identity.
Across all of it, his aim is the same: to help patients, families, and the public engage with mental health more honestly, with less oversimplification and less noise. He is currently writing a book, The Myths and Misunderstandings of Psychiatry, and is a contributor to KevinMD. He shares updates on LinkedIn.
Conditions
When I tell a patient that she has major depressive disorder, something subtle happens in the room. What I mean and what she hears may be two very different things. I may mean that her symptoms meet an established set…
When I tell a patient that she has major depressive disorder, something subtle happens in the room. What I mean and what she hears may be two very different things.
I may mean that her symptoms meet an established set of criteria: depressed mood, loss of interest, changes in sleep or appetite, impaired concentration, and enough distress or dysfunction to cross a diagnostic threshold. She may hear something considerably stronger: The …
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What a psychiatric diagnosis means is not an explanation
Conditions
"I think I might be autistic." "I hate eye contact." "I get overwhelmed by loud noises." "I'm really good at masking it." Autism has become one of the most widely self-diagnosed conditions on social media, and for understandable reasons: Nearly…
“I think I might be autistic.” “I hate eye contact.” “I get overwhelmed by loud noises.” “I’m really good at masking it.” Autism has become one of the most widely self-diagnosed conditions on social media, and for understandable reasons: Nearly everyone recognizes something of themselves in the traits now described online as autistic, disliking small talk, needing routine, having an intense interest, feeling drained after a party. None of that, …
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The autism spectrum diagnosis may be too broad a label
Conditions
"I'm so OCD." "I think I'm a little OCD, I like things neat." Clinicians hear versions of this constantly, said casually, sometimes as a joke, sometimes with a note of pride. The person is usually describing themselves as particular, exacting,…
“I’m so OCD.” “I think I’m a little OCD, I like things neat.” Clinicians hear versions of this constantly, said casually, sometimes as a joke, sometimes with a note of pride. The person is usually describing themselves as particular, exacting, or a little controlling. Almost none of it has anything to do with obsessive-compulsive disorder (OCD).
OCD is defined by intrusive, unwanted thoughts that generate real anxiety, disgust, or dread, and …
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OCD misconceptions turn a serious illness into a quirk
Conditions
Few psychiatric terms have migrated into everyday language as completely as "bipolar." It is now routinely used to describe irritability, emotional volatility, and rapid shifts in mood. Yet this widespread usage reflects a fundamental misunderstanding of the condition itself. At…
Few psychiatric terms have migrated into everyday language as completely as “bipolar.” It is now routinely used to describe irritability, emotional volatility, and rapid shifts in mood. Yet this widespread usage reflects a fundamental misunderstanding of the condition itself.
At the center of the confusion is a mismatch of scale. The public conception of “mood swings” involves rapid fluctuation, changes occurring over minutes or hours. These shifts may be mild, or …
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Mood swings and bipolar disorder are not the same thing
Conditions
"I've never really been able to focus, but it's only become a real problem in the last few years, since I started this job. Could I be evaluated for adult ADHD?" I hear a version of this request often, and…
“I’ve never really been able to focus, but it’s only become a real problem in the last few years, since I started this job. Could I be evaluated for adult ADHD?”
I hear a version of this request often, and it captures a confusion built into the term itself. “Adult ADHD” sounds like it names a condition that begins in adulthood, the way adult-onset diabetes or adult-onset asthma can. It doesn’t, …
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Adult-onset ADHD is a naming problem, not a new disorder
Conditions
A mother sat across from me recently, her twelve-year-old beside her, and asked a question I have heard in one form or another hundreds of times over two decades of practicing psychiatry: "Can we just get her tested? I want…
A mother sat across from me recently, her twelve-year-old beside her, and asked a question I have heard in one form or another hundreds of times over two decades of practicing psychiatry: “Can we just get her tested? I want to know, scientifically, what she has.”
She wasn’t asking for a diagnostic interview. She was picturing something closer to what happens elsewhere in medicine when a symptom is uncertain: a scan, …
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Why there is no test for mental illness, and won’t be
Conditions
Psychiatry occupies a place in public discourse that no other medical specialty does. Its language permeates everyday conversation, its concepts appear in film and literature, and its diagnoses are invoked casually in both social and digital spaces. No cardiologist or…
Psychiatry occupies a place in public discourse that no other medical specialty does. Its language permeates everyday conversation, its concepts appear in film and literature, and its diagnoses are invoked casually in both social and digital spaces. No cardiologist or gastroenterologist encounters anything quite comparable.
Psychiatry deals directly with the domains that define human experience: emotion, thought, behavior, and relationships. Unlike ischemia or amyloid deposition, these are not biological processes removed …
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When mental health labels become part of who we are
Conditions
"My mother is bipolar. My brother has OCD. I'm sure this runs in the family." I hear some version of this in nearly every intake, and I understand why. Family history is a genuinely powerful tool in most of medicine.…
“My mother is bipolar. My brother has OCD. I’m sure this runs in the family.” I hear some version of this in nearly every intake, and I understand why. Family history is a genuinely powerful tool in most of medicine. It helps estimate genetic risk and sharpen diagnostic reasoning. In psychiatry, it’s often treated as carrying that same evidentiary weight. Too often, it doesn’t earn it.
Disease broadly falls into two …
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Family history in psychiatry: Ask why, not whether
Conditions
"I have a lot of anxiety and stress. Can I get Prozac, Lexapro, or something like that?" "My moods are all over the place. One moment I'm happy, the next I'm sad, the next I'm enraged. Can I get a…
“I have a lot of anxiety and stress. Can I get Prozac, Lexapro, or something like that?”
“My moods are all over the place. One moment I’m happy, the next I’m sad, the next I’m enraged. Can I get a mood stabilizer?”
I hear requests like these constantly. They’re completely understandable. They also reflect a common misunderstanding: that psychiatry works the way the rest of medicine does, where a symptom leads straight …
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Why a psychiatric diagnosis is not a biological target
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