The separation of mental and physical health care still rests on a Cartesian inheritance, the old assumption that mind and body are fundamentally different kinds of things, one physical and mechanical, the other immaterial and spiritual. That framework may have…
The separation of mental and physical health care still rests on a Cartesian inheritance, the old assumption that mind and body are fundamentally different kinds of things, one physical and mechanical, the other immaterial and spiritual. That framework may have served a purpose in an era when medicine lacked the tools to explain what it could not measure, allowing physicians to attend to the body while matters of the mind …
Somewhere today, an ICU survivor is leaving the hospital. They survived septic shock. Respiratory failure. Multiple traumatic injuries. They are grateful to be alive. What they do not know is that the research designed to help them recover more safely…
Somewhere today, an ICU survivor is leaving the hospital. They survived septic shock. Respiratory failure. Multiple traumatic injuries. They are grateful to be alive.
What they do not know is that the research designed to help them recover more safely at home may never be completed.
In mid-July, the Agency for Healthcare Research and Quality (AHRQ) began notifying researchers across the country that dozens of active research grants would be terminated. As …
Both lay dabblers and scholars of history repeatedly admonish us that history repeats itself. Historical context can help us understand and grapple with issues that have plagued and continue to plague humankind. The United States is not alone in having…
Both lay dabblers and scholars of history repeatedly admonish us that history repeats itself. Historical context can help us understand and grapple with issues that have plagued and continue to plague humankind.
The United States is not alone in having a dubious record of misogyny and glaring inequities in the treatment of women and people of color. In recent decades, people have re-examined historical teachings through the lens of human rights, …
Medical fields don't evolve because someone discovers a new molecule. They evolve because someone notices something obvious that everyone else has learned to ignore. In developmental-behavioral pediatrics, what shaped my early career was four studies that ended up influencing the…
Medical fields don’t evolve because someone discovers a new molecule. They evolve because someone notices something obvious that everyone else has learned to ignore. In developmental-behavioral pediatrics, what shaped my early career was four studies that ended up influencing the field more than I expected. I didn’t set out to be a contrarian. I simply had a habit of asking questions that didn’t fit the standard research template.
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 …
A nurse survived a violent assault at work, then watched her hospital treat her like a liability, not a victim. In this episode, June Garen, a retired psychiatric and operating room nurse and author, and Carleigh Beriont, a former union…
A nurse survived a violent assault at work, then watched her hospital treat her like a liability, not a victim. In this episode, June Garen, a retired psychiatric and operating room nurse and author, and Carleigh Beriont, a former union organizer who teaches U.S. history and public policy, explain why violence …
An excerpt from Medicine Versus Politics: Three Tales of Patient Survival. Deception has always been a weapon, but in our time it has become a system. In medicine especially, where facts should be the most trusted currency, lies can wound…
Deception has always been a weapon, but in our time it has become a system. In medicine especially, where facts should be the most trusted currency, lies can wound as surely as disease itself. Repetition, amplification, and manipulation turn rumor into “truth” at a frightening pace. When politics co-opts this process, the consequences are not merely theoretical; they can …
"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, …
A randomized controlled trial can tell us that a treatment reduces mortality by a measurable percentage. It cannot tell us what it feels like to receive that treatment, to wait for its results, or to watch someone you love decide…
A randomized controlled trial can tell us that a treatment reduces mortality by a measurable percentage. It cannot tell us what it feels like to receive that treatment, to wait for its results, or to watch someone you love decide whether to accept it. That gap, between what medicine measures and what patients actually experience, is where fiction has always done work that research papers cannot.
What if burnout is the wrong word for what doctors are actually going through? Gus W. Krucke argues that calling physicians burned out treats a systemic failure as a personal one, and that physicians are not failing, they are grieving…
What if burnout is the wrong word for what doctors are actually going through? Gus W. Krucke argues that calling physicians burned out treats a systemic failure as a personal one, and that physicians are not failing, they are grieving a profession that has changed around them. Using a malpractice case …
We are living through a massive, rapid shift in how we approach human health, and as I watch the excitement surrounding the new generation of glucagon-like peptide-1 (GLP-1) agonists, I can't help but see a familiar ghost in the room.…
We are living through a massive, rapid shift in how we approach human health, and as I watch the excitement surrounding the new generation of glucagon-like peptide-1 (GLP-1) agonists, I can’t help but see a familiar ghost in the room. It feels exactly like the early days of the selective serotonin reuptake inhibitor (SSRI) revolution, a time when we were all so eager for a solution that we sometimes overlooked …
I work with many victims of gaslighting around the country. We learn from each other. Those who have lost their licenses to work can follow these steps to regain their licenses and resume their careers. First, acknowledge that any victim…
I work with many victims of gaslighting around the country. We learn from each other. Those who have lost their licenses to work can follow these steps to regain their licenses and resume their careers.
First, acknowledge that any victim of gaslighting suffers some degree of PTSD. Severe gaslighting leads to complex PTSD. The federal Americans with Disabilities Act (ADA) laws put in place before 2000 state that those suffering from …
Earlier this summer, I wrote about "summer SAD," the very real worsening of mood, anxiety, agitation, and sleep that some people experience during the hottest and brightest months of the year. After this weekend, I think the conversation needs to…
Earlier this summer, I wrote about “summer SAD,” the very real worsening of mood, anxiety, agitation, and sleep that some people experience during the hottest and brightest months of the year.
After this weekend, I think the conversation needs to go further. Temperatures in the Sacramento area have exceeded 100°F, and over the past several days I have seen multiple previously stable patients experience abrupt and clinically significant psychiatric destabilization.
I have spent a career writing, teaching and speaking about the power of spoken word. I bring a rhetorical understanding of language to various settings: how medical professionals talk, how we talk about people with disabilities, talk within interpersonal relationships…
I have spent a career writing, teaching and speaking about the power of spoken word. I bring a rhetorical understanding of language to various settings: how medical professionals talk, how we talk about people with disabilities, talk within interpersonal relationships and now, talk about COVID. By rhetorical understanding, I mean that words have meanings, are persuasive, contain energy, and have consequences. In short, words create worlds. I refer to this …
An excerpt from Live for Me, Nkem. We fall into silence for a while before she says, "So what has Nkem done this time?" My eyes meet hers. She crosses her arms, watching me like someone bracing for a fight.…
Most of us know the experience of something unexpected happening and reacting before we pause long enough to engage our frontal lobe. We hear ourselves say something we do not mean, feel anger surge before we understand why, or watch…
Most of us know the experience of something unexpected happening and reacting before we pause long enough to engage our frontal lobe. We hear ourselves say something we do not mean, feel anger surge before we understand why, or watch ourselves react in a way that feels misaligned with who we believe we are. We say, “I saw red,” “It felt like I was outside my body,” or “I do …
In The Birth of the Clinic, Michel Foucault introduced the concept of the "medical gaze" to describe how physicians translate a patient's lived experience into biomedical terms, emphasizing information that fits a clinical framework while setting aside what does not.…
In The Birth of the Clinic, Michel Foucault introduced the concept of the “medical gaze” to describe how physicians translate a patient’s lived experience into biomedical terms, emphasizing information that fits a clinical framework while setting aside what does not. Every gaze involves selecting certain details from the vast stream of sensory information. In medicine, that selection often privileges disease, symptoms, and measurable findings while overlooking the personal, social, and …
Medical school had trained me to move quickly; there was always another exam to prepare for, another deadline to meet, another task to attend to as I worked toward the next milestone. When I learned that I would need to…
Medical school had trained me to move quickly; there was always another exam to prepare for, another deadline to meet, another task to attend to as I worked toward the next milestone. When I learned that I would need to remediate, what initially felt like an academic setback gradually became something else: an opportunity to notice habits I had carried into both medicine and my relationships.
At 5 p.m., the clinic closes. The appointment schedule ends, routine messages move into the next business day's queue, and results that arrive later may wait for review. Patients are directed to an after-hours line, urgent care, or the emergency…
At 5 p.m., the clinic closes. The appointment schedule ends, routine messages move into the next business day’s queue, and results that arrive later may wait for review. Patients are directed to an after-hours line, urgent care, or the emergency department if the situation cannot wait.
Illness follows a different schedule. A medication started on Wednesday causes dizziness on Friday night. A fever rises on Saturday. Pain that was intermittent during …
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 …
