For the better part of the last two decades I have practiced psychiatry in a variety of different American health care systems, and over these years I have, on numerous occasions, heard psychiatric services referred to in manner that imply (often subtly) that such services are not medical care.  These references come not only from patients, but nurses and doctors (including myself) too. “Yes Mr. Jones you need to follow up ...

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I am not strongly against the death penalty on principle or on moral grounds -- assuming, of course, that it could somehow be narrowly and efficiently restricted to a very few egregiously deserving and certainly guilty criminals. I don't even find it particularly appalling (or cruel and unusual) punishment that a killer may have some few minutes of physical discomfort before expiring during a clumsily administered execution. My experience as a ...

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The interview had lasted fifteen minutes so far, and we'd made minimal progress. I was a medical student doing a rotation at a physical medicine and rehabilitation clinic back in my home state, Wisconsin. It was the end of the day; to save time, the senior resident, Paul, had joined me in the exam room so that we could hear Leora's medical history together. A year earlier, Leora, in her mid-fifties, ...

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“Is it weird that I cut myself on purpose?” A 14-year-old girl from a local middle school asked me this question at work last week. In my years as a Teen Xpress counselor, I have been asked about self-injurious behaviors many times. They ask: “What is it about?” “Isn’t it just a way to get attention?” “Why would someone do that?” “Are they trying to kill themselves?” It’s not only teens that ask about self-injury. I’ve ...

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Floor technician. Environmental technician. Life coach. Investment and retirement strategist. Facility safety coordinator. Interventional cardiologist. Cardiothoracic and vascular surgeon. Neurodevelopmental psychologist. Are we hiding behind out words? Worse yet, are we afraid to be who we really are? Maintenance man. Trash man. Knowledgeable and experienced friend. Salesman. Security guard. Doctor. Psychologist. I see it every day. Someone comes to me for a run-of-the-mill mental health problem, absolutely nothing to be ashamed of, and asks for help. For whatever reason, when we get to the social history ...

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Back when Prozac (fluoxetine) and Zoloft (sertraline) were new, I remember the mental acrobatics doctors made to justify giving these drugs to anxious patients. The drugs were approved for treating depression, but we knew they often seemed to help anxiety. The reason, we were told, was that some anxious patients were actually depressed, deep down, and we had just failed to recognize their depression. Now, with studies to support their use ...

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Our nation has recently witnessed another tragedy involving a young adult, with young adult victims. Facts often emerge slowly and it is important not to speculate about diagnoses through the news media; however, it seems clear in this case that mental illness is a factor -- even though few people living with mental illness are violent. To avoid tragedies, solutions are needed.  One area of real promise is early ...

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Mental health patients and their families already pay a hefty price with the stigma of mental illness and the emotional roller coaster they often face dealing with symptoms. But insufficient mental health resources across the United States also means that they must pay a financial price as well in the form of lost productivity, out-of-pocket costs for treatment and sometimes periods of unemployment. A recent USA Today special report estimates that benefits ...

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When my son Ben was 20-years-old, he was finally diagnosed with schizophrenia after five years of chaos and frustration -- what I later came to know had been symptoms of the gradual onset of his illness. At the time, I’d thought he was just having a tough adolescence. I’d thought perhaps he needed more father figures (Ben’s father had deserted the family when Ben and his sister were little, and ...

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Top stories in health and medicine, June 20, 2014From MedPage Today:

  1. The Uninsured: 33 Million and Counting. In the last full year before the Affordable Care Act went into effect, more than 33 million Americans had been without health insurance for more than a year, according to CDC survey.
  2. Gross Anatomy: A Real Twisted Heart. It's nothing but heartache for ...

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