I’m reluctant to write a post about ADHD. It just seems like treacherous ground. Judging by comments I’ve read online and in magazines, and my own personal experience, expressing an opinion about this diagnosis—or just about anything in child psychiatry—will be met with criticism from one side or another. But after reading L. Alan Sroufe’s article (“Ritalin Gone Wild”) in the New York Times, I feel compelled to write.If ...
Steve Balt, MD
The erosion of psychiatric training has consequences
One of my most vivid memories of medical school was during my internal medicine rotation, when it had become apparent to me that, despite spending my pre-clinical years studying complex pathophysiology and pharmacology, and the fine art of history-taking and the physical exam, the actual clinical work seemed to be more like a numbers game. I felt like I was always responding to a data point: a blood pressure reading, ...
Psychiatry should not be a tool for social justice
A doctor’s primary responsibility is to heal, and all of our efforts and resources should be devoted to that goal. At times, it is impossible to restore a patient to perfect health and he or she must unfortunately deal with some degree of chronic disability. Still other times, though, the line between "perfect health" and "disability" is blurred, and nowhere is this more problematic than in psychiatry.To illustrate, consider ...
Do patients accept hurried, fragmented, disconnected care?
A cover story by Gardiner Harris in the New York Times spotlights the changes in modern psychiatry, from extensive, psychotherapy-based interaction to brief, medication-oriented “psychopharm” practice.The article shares nothing new, particularly to anyone who has paid any attention to the rapid evolution of the psychiatric profession over the last ten years (or who has been a patient over the same period). While the article does a nice ...
Current psychiatric drugs are only marginally effective
The scientific journal Nature ran an editorial recently with a rather ominous headline: "Psychopharmacology in Crisis." What exactly is this "crisis" they speak of? Is it the fact that our current psychiatric drugs are only marginally effective for many patients? Is it the fact that they can often cause side effects that some patients complain are worse than the original disease? No, the “crisis” is that the ...
Does psychiatry treat symptoms or diseases?
Do we treat diseases or symptoms in psychiatry? While this question might sound philosophical in nature, it’s actually a very practical one in terms of treatment strategies we espouse, medications and other interventions we employ, and, of course, how we pay for mental health care.It’s also a question that lies at the heart of what psychiatry is all about.Anyone who has been ...
Treatment-resistant depression is a myth
Treatment-resistant depression is one of those clinical terms that has always been a bit unsettling to me.Maybe I’m a pessimist, but when I hear this phrase, it reminds me that despite all the time, energy, and expense we have invested in understanding this all-too-common disease, we still have a long way to go. Perhaps more troubling, the phrase also suggests an air of resignation or abandonment: "We've tried everything, but ...
