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 […]

Diagnosing Donald Trump

On January 31, 2017, the Psychology Today editorial staff published a well-balanced summary of the debate over whether to declare President Trump mentally ill. While the debate focuses on mental health professionals such as psychiatrists and psychologists who are credentialed to make such diagnoses, the question clearly goes further. Public commentary following this and other […]

Is the DSM clinically useful?

Prior to the release of DSM-5 in 2013, I referred at times to the pocket copy of DSM IV parked in my office bookcase. The main reason was to enter the right diagnostic codes on insurance forms. I also sometimes quoted DSM criteria to show a patient that ADHD can’t arise in adulthood, that daily […]

“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 […]

Parenting medical disruptors

Popularized telemedicine — that is, teleconferencing with a physician over one’s smartphone — worries many critics because it assumes patients can be evaluated without a physical exam. The critics are right that those with a financial interest in “disrupting” health care typically minimize the trade-offs. Convenience and lower cost are trumpeted, while risks of misdiagnosis […]

Enjoying clinical uncertainty

Lucia Sommers of the Department of Family and Community Medicine at UC San Francisco commented on my last post, noting that clinical uncertainty among primary care physicians (PCPs) is usually regarded as tolerable at best. She was delighted that I called such uncertainty intellectually attractive, and something to embrace in psychiatry. Sommers and her coauthor […]