In a world of diverse mental health treatments and treatment settings, psychoanalysis and psychodynamic psychotherapy have lost their former prominence.  Only a small fraction of patients have the time, money, and interest to engage in long-term, open-ended mental exploration -- even if doing so would get to the root of their problems and lead to lasting improvement. More commonly, emotional distress is dealt with in emergency departments, in crisis clinics, on the medical and surgical floors of hospitals, in ...

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No matter how well the one you love ornaments your life, they should never be an ornament. Meaning — you should never have to find them hanging in the closet like it's some tree where each broken branch represents sadness, sickness and issues that only make sense in hindsight. That metaphorical tree was as astonishing as Christmas morning yet as terrible as a Halloween horror. And although surreal — like Dali ...

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A few weeks after I started residency, two of my peers killed themselves in New York City. No one I knew was surprised. Intern year is hell, and everybody knows it from TV shows like "Scrubs" and books like "House of God." Old doctors tell tall tales of working a million hours without sleep before training standards got “soft,” limiting residents’ monthly work hours to 320 and requiring four days off. ...

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Those of us who work in pediatric intensive care have frequent encounters with the problem of suicide and attempted suicide. It has seemed to me for some years that the numbers are increasing, and this has been shown to be the case. After years of declining, the suicide rate in our country has been increasing, now at about 125 percent of the rate of several decades ago. This increase ...

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I’ve known since I was very young that I just experienced life differently than did my extroverted family members and friends. During parties, they seemed to truly enjoy the loudness and chaos of get togethers and the seemingly endless small talk, while I would secretly yearn to return home so that I could read my latest novel in peace. An older family member once told me that I would eventually ...

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My cohort graduated from our psychiatry residency almost ten years ago. The level of frustration and disappointment we’ve all experienced within the past two years is striking. Some have taken leadership roles, only to relinquish them because of fatigue from fruitless discussions with administrators. Others have tried to alert senior managers about dangerous and irresponsible clinical practices. Their efforts were unsuccessful because concerns about finances trumped concerns about clinical services. With ...

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Many patients are referred to me as a psychiatrist to treat their depression.  The new patients that come to me for depressive symptoms usually expect that I will be recommending and prescribing an antidepressant for their depressive symptoms because that is what a psychiatrist does, right?  Not always. Often times these patients come to me having gone through several antidepressant trials without any successful resolution of their depressive symptoms.  Well, sometimes ...

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“I attribute my success to this-I never gave or took any excuse.” -Florence Nightingale I was publically thanked today for doing my job. No, really. By two of my coworkers, actually. It sort of took me aback just a bit. Over the past Christmas holiday a couple of patients, being human as we all are, forgot to get their medications squared away before the clinic was going to close for a total of ...

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Medical science is moving forward at breakneck speed.  Advancements in stem cell research, robotics and nanotechnology promise a new era of molecularly targeted medications, replacement body parts, and regenerative treatments to combat disease and decline.  But if a picture is worth a thousand words, then the footage of Jimmy Carter, looking healthy at the inauguration, his advanced melanoma now in remission, says more about our accomplishments than a year’s worth ...

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I use an ongoing spreadsheet to keep track of and to report my demographics and stats for each telepsychiatry consult shift I do. I’ve done thousands of consults in over two dozen South Carolina emergency departments over the last half-dozen years. We have now gone over thirty thousand consults as a group. It never ceases to amaze me, as I fire up my computer, log on to my systems and bring ...

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