Psychodynamically informed clinical work

In a world of diverse mental health treatments and treatment settings, psychoanalysis and psychodynamic psychotherapy have lost their former prominence. Only a small fraction of patients have the time, money, and interest to engage in long-term, open-ended mental exploration — even if doing so would get to the root of their problems and lead to […]

“Brain disease”: the anti-psychiatrists respond

I don’t avoid reading opinions strongly critical of psychiatry. They help sharpen my reasoning skills. It’s always possible they might alter my views in some way. And like most everyone, I consider myself openminded and receptive to criticism. However, after years of reading Thomas Szasz, Robert Whitaker, and the screeds of the less articulate, after […]

Are psychiatric disorders brain diseases?

Some maladies that attract psychiatric attention are unequivocally brain diseases. Huntington’s disease. Brain tumors. Lead poisoning. However, these are not psychiatric diseases. Huntington’s is a genetic abnormality diagnosed and treated by neurologists. Brain tumors are managed by neurosurgeons and oncologists. Lead toxicity is treated by internal medicine. Indeed, a long list of medical and surgical […]

Defining the competent psychiatrist

What defines a competent psychiatrist? To staunch critics of the field, perhaps nothing. Some believe psychiatry has done far more harm than good, or has never helped anyone, rendering moot the question of competency. What defines a competent buffoon? A skillful brute? An adroit half-wit? Having just finished Robert Whitaker’s Anatomy of an Epidemic: Magic […]

OpenNotes: Good intentions gone awry

OpenNotes is “a national initiative working to give patients access to the visit notes written by their doctors, nurses, or other clinicians.” According to their website, three million patients now have such access, generally online. Participating institutions include the MD Anderson Cancer Center in Texas, Beth Israel Deaconess in Boston, Penn State Hershey Medical Group, […]

Military brain-chips to cure psychiatric disorders?

Sounding like something straight out of science fiction, DARPA recently announced grants to fund research and development of implantable brain-stimulation chips aimed to relieve, or even cure, mental disorders. The Defense Advanced Research Projects Agency thinks big, and it has the money, i.e., our tax dollars, to back it up. Decades ago, DARPA brought us […]

Psychiatric uncertainty and the neurobiological buzzword

A few years ago I wrote that uncertainty is inevitable in psychiatry. We literally don’t know the pathogenesis of any psychiatric disorder. Historically, when the etiology of abnormal behavior became known, the disease was no longer considered psychiatric. Thus, neurosyphilis and myxedema went to internal medicine; seizures, multiple sclerosis, Parkinson’s, and many other formerly psychiatric […]