A paradigm is a way of thinking about things. For the past 60 or so years, our thinking about mental health and illness has been dominated by what can be referred to as the “DSM (Diagnostic and Statistical Manual of Mental Disorders) paradigm.” What this looks like in everyday practice is that when a child is referred to my behavioral pediatrics practice for say, anxiety, the questions that parents, referring …
We need to move beyond the DSM paradigm
Sexual abuse is shockingly common in the U.S. prison system. A recent survey conducted by the Bureau of Justice Statistics concluded that each year about 200,000 prisoners are victims of coercive sex.
Most of the those abused are psychiatric patients misplaced in prison. They make vulnerable targets — less able to defend themselves and less likely to be believed if they report infractions.
Prisons are clearly not an appropriate or safe place …
The degradation prison life can hold for psychiatric patients
Once upon a time I saw a patient for followup, a woman I had seen for several visits in the past. She had voiced the usual oft-heard complaints about insomnia, changes in appetite, lack of energy, diminished interest in pleasurable activities, and other associated symptoms of chronic depression. Most of these had been addressed and had gotten at least partially better, to the point that her overall quality of life …
The hallucinations that psychiatric patients experience
Recently, I was bemoaning the fact that while the first conference specifically addressing diabetes and depression was a good start, there really wasn’t a significant patient presence. Lots of experienced professionals in the field, but startling few people who had actually walked-the-walk with significant depression for years, decades even.
While this format will surely offer a lot of information from the professionals viewpoint, it seems that it would be a bit …
Are patients marginalized at health conferences?
As a psychiatry resident with both a personal interest in meditation and a professional interest in integrating eastern mindfulness practices into western psychiatry, I like to keep up with the latest research on the subject. And I can’t help but notice how trendy the topic has become.
My last literature search turned up articles like “Pilot randomized trial on mindfulness training for smoking in young adult binge drinkers,” “Mindfulness-based program for …
Why mindfulness has a place in psychiatry
I love football.
There is one thing that I absolutely believe to be true about the sport I love.
Any given team can beat any other team on any given day.
Sometimes my love of sports and the little metaphors that sprout from it spill over into my workspace as well.
At the end of each shift I work in telepsychiatry, one of the last things I do is complete an electronic log of …
The vast majority of folks I see want to kill themselves
We do not have medical records or diagnoses. The news is filled with speculation. What we do know is that Miriam Carey’s one-year-old daughter lost her mother, and that because the incident occurred in Washington, DC in front of the White House, it is shining a spotlight on the subject of mental health and motherhood. And the message should be simple. Diagnoses don’t matter. As part of our nation’s health …
Miriam Carey: The lessons of motherhood and mental illness
At the end of medical school, when it was time to choose my specialty, I was torn between psychiatry and internal medicine. Psychiatry seemed most suited to my interests and aptitudes. Focusing on the mind and mental illness bridged my interest in the big questions of human existence and the practice of medicine. On the other hand, it was hard to see how being a psychiatrist would fit with the …
When electroconvulsive therapy is the right choice
When is it justified to force treatment on someone?
Some would shout a resounding,impassioned, all inclusive, “Never!” No psychiatric coercion, not ever, not even under the most seemingly urgent of circumstances.
I once put the question to its supreme test — 35 years ago while having dinner with Tom Szasz. Tom was the probably the greatest defender of patient rights since Pinel (the father of modern psychiatry who, two centuries ago, started …
The conundrum of forcing treatment on psychiatric patients
At long last, people are talking about postpartum depression. Dismissed for years as no more than a touch of the baby blues or else unheard of entirely, postpartum depression — or PPD, as it is often known — has become an open subject. Healthcare providers are aware of it, many nurses and physicians routinely screen mothers for it, and articles in parenting magazines and major newspapers have been written about …
How postpartum depression affects children
I received a very intriguing question the other day.
“What happens when someone despicable, someone who has committed some horrible act or made some terrible decision, comes in for evaluation or treatment and you have to see them?”
I have been asked to see child molesters of the worst kind, men (usually) who have done things so vile to children that it would make your stomach turn to hear about them. Having …
Why the despicable deserve the best care possible
Another tragedy, another tragic series of errors, another avalanche of debriefings and politicization, and in Washington, DC, there are 12 more dead. What can we say about this? It seems that the standard commentary fails. Aaron Alexis was not an angry white man, nor a conservative. He carried no assault rifle and he had a secret security clearance. He doesn’t seem to have been motivated by race. He was a …
Why solutions to mental health continue to evade us
I don’t think of myself as someone who is easily angered. In my capacity as a mental health provider, I have been called every name in the book, spat at and nearly assaulted. Although these experiences are never pleasant, I can intellectualize away my feelings about patients’ hostile behavior: this is just a part of their illness. While I have certainly felt frustrated after a long night on call, I …
Parenting the crying child: Remember to take care of yourself
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Imagine there was a practice that I could teach you that would reduce your relative risk of having a heart attack by nearly 40%. Imagine also that if you carried out this practice just once a week you’d find yourself feeling less anxious, more confident, better able to enjoy yourself socially, and in general significantly less stressed (at least while actively engaged …
Think about alcohol as a prescription drug
The medical board of the state of Oklahoma recently sanctioned a physician for using Skype to conduct patient visits. A number of other factors add color to the board’s action, including that the physician was prescribing controlled substances as a result of these visits and that one of his patients died. This situation brings up several challenges of telehealth — that is, using technology to care for patients when doctor …
Using Skype for patient visits: A doctor is sanctioned
So what is the one thing that I see over and over and over again in the management of emergency room psychiatric patients that makes me fear for our survival as a country and even as a species?
Is it the severity of psychotic illness? The rampant drug and alcohol use that starts now when kids are pre-adolescent? Is it the broken families that are producing another generation of children who …
Going all the way should mean more than completing high school
On September 17, 2013, I joined the growing ranks of physicians who have gotten a message they hoped never to receive: “There has been a mass shooting in the area. Prepare to receive casualties.”
That morning, a gunman was indiscriminately mowing down people at the US Navy Yard. Within an hour my hospital had geared up to provide both medical and supportive care, answer calls from those seeking to know the …
Unregulated gun access and its drain on medical resources
Days from her 80th birthday, “Nancy” (not her real name) is doing well. She’s active, exercises, drives, travels, and lives alone in a multi-story apartment building without an elevator. Her busy schedule of weekly activities includes several appointments with physicians. Nancy’s medical needs are covered by Medicare.
Nancy’s been in psychotherapy for a half-century. She’s seen me, her psychotherapist, for the past three years. Nancy reports difficulty developing meaningful …
A symptom that will hasten Medicare’s eventual insolvency
My patient Maria sits before me, looking vaguely distressed.
She’s returned for a follow-up visit, six weeks after our first. The morning is half over, and I’m clipping along, staying on time, using the new electronic medical record system (EMR) without a glitch and with a sense of satisfaction. Three months back, when I joined this small-town practice as part of my new position as a health-system medical director, I found …
I’m grateful that I’ve been given a second chance
Whether delivered by a boss regarding a work goal, by a coach regarding an athletic performance, or by a trusted reader regarding the quality of a rough draft, the feedback we get often powerfully influences our ability to succeed. Yet significant controversy exists in the scientific literature about which type of feedback, positive or negative, is most effective.
As researcher Ayelet Fishbach explains: ”Several motivation theories attest that positive feedback is more …
Positive or negative feedback: Which is best?
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