Hiring the one-armed surgeon

Two of the most commented posts on my blog are about charging patients for missed sessions and how psychotherapies end. As there is no single correct approach to either of these, there’s plenty of room for practices legitimately to vary, and plenty of room for patients, i.e., most of my commenters, to express their likes […]

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 […]

Borderline personality disorder: parasuicide

In my last post, I highlighted diagnostic challenges related to borderline personality disorder (BPD): Sometimes dramatic, self-destructive behavior leads to reflexive, inaccurate use of this label, while other times eagerness to diagnose a medication-responsive illness such as bipolar disorder can lead to overlooking BPD. Naturally, this barely scratches the surface. Thousands of books have been […]

Borderline personality disorder: diagnosis

Just as I was formulating a few thoughts on borderline personality disorder (BPD), I see the NY Times beat me to it. Jane E. Brody’s 6/15/09 “Personal Health” column, “An Emotional Hair Trigger, Often Misread,” provides an evocative description of this vexing disorder. Brody’s column seems informed largely by her consultant, Dr. Marsha M. Linehan, […]