The high-risk psychiatric patient

A woman recently requested a medication evaluation at the suggestion of her psychotherapist. The caller told me her diagnosis was borderline personality disorder. She hoped medication might ease her anxiety. She also admitted that two other psychiatrists refused to see her because she was too “high risk.” I asked if she was suicidal. Yes, thoughts […]

Credulity

As we grow into adulthood, each of us develops a personal comfort zone located on the continuum between paranoia and gullibility. A few of us are highly suspicious by nature, a few are unwitting dupes; most of us are in between. Mental health professionals are no exception, and it shows in our work. Is a […]

We are all fallible experts

It’s a blessing and a curse that we humans are such adept conceptualizers and heuristic thinkers. We continually compare our perceptions about the world to paradigms in our head, performing quick, unconscious goodness-of-fit assessments. We instantly sense danger when a large furry beast rapidly advances. We don’t waste time discerning whether it’s a lion or […]

Medical professionalism vs commercialism

The history of American medicine is the story of the rise and fall of a professional guild. In the 19th and early 20th Centuries, physicians distinguished themselves from other healers by banding together to form professional associations dedicated to science-based practice. Even more important, medical ethics put the patient first, above considerations of personal gain […]

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 […]

Do patients avoid psychiatrists for fear of legal holds?

Over on the Shrink Rap blog I got caught up in an off-topic debate. The post was on why psychiatrists avoid insurance panels, something I’ve written about myself. But the commentary wandered into exorbitant fees, inadequate mental health services for the poor, income disparity between psychiatrists and patients, a generation that expects something for nothing, […]

Loss of privacy and the new psychic numbing

I grew up in the era of the nuclear arms standoff. Thousands of warheads on land, at sea, and in planes stood ready to obliterate most of the human race if the Soviets, Americans, or a rogue third nation launched a nuclear “first strike.” Authors of that era wrote of the psychological effects of living […]