Who is mentally ill?

My fellow psychiatrist and blogger Dinah Miller raised this simple yet profound question on Shrink Rap the other day. Who is rightfully labeled mentally ill? Is it anyone with a psychiatric diagnosis, past or present? Anyone with currently active psychiatric symptoms? Anyone receiving psychiatric treatment? Dr. Miller observes that “the mentally ill” is an oft-cited […]

Third-party payment for psychotherapy: (1) "Do you take Medicare?"

From late 1996 to early 2007 I was medical director of a low-fee mental health clinic where psychiatry residents and psychology interns receive training. Since the clinic accepted Medicare for payment, I did as well. I signed on as a Medicare “preferred provider” and have remained on the panel ever since, even though I left […]

Going to the APA meeting?

The annual meeting of the American Psychiatric Association (APA) is in San Francisco this May. I’ve attended twice before as I recall, both times when it was here. I enjoyed it, and even felt it was worth the $1000 we non-members pay to get in, although in my opinion it’s not worth doubling that for […]

Narcissists, psychopaths, and other bad guys

A patient of mine recently observed that the increasing use of the the term “psychopath” in popular media is really a disguised way of criticizing selfishness. Dressing up selfishness as an odd and frightening clinical disorder — slapping a diagnostic label on it — makes for catchy news copy, and grants pundits emotional distance between […]

Chemical imbalance — Sloppy thinking in psychiatry 1

There’s a lot of sloppy thinking in my field. This troubles me. While psychiatry inevitably deals with the speculative and poorly understood, this surely cannot excuse faulty logic and intellectual laziness. Worse yet, this laxity of thought extends across the field, from biological psychiatry to psychotherapy, and from the general to the specific. My next […]

The commodification of psychiatry

Several recent articles, blogs, and even my participation in HealthTap (discussed in my last two posts) have led me to think about how psychiatry, and mental health treatment generally, are increasingly viewed as commodities. In the language of economics, a commodity is a physical good, such as food, grain, or metal, which is interchangeable with […]

Efficacy of dynamic psychotherapy

The following post is an adaptation of an argument I presented on Sacramento Street Psychiatry, my blog on the Psychology Today website. As usual, I welcome your comments.

Western medicine’s great strides are largely due to understanding etiology (the biological basis of disease), defining a nosology (a system of categorizing diseases), and testing treatments aimed […]