Years ago, the police brought a middle-aged man to the hospital for evaluation on a day when I was the on-call psychiatrist. Earlier that morning, the man had walked into his psychiatrist’s office without an appointment asking to see his doctor immediately. When his demand was not met, he caused a raucous in the waiting room, tossing over tables and chairs and alarming the other patients. He refused to leave, ...

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As a psychiatrist, I’ve spent almost two decades caring for patients who have survived sexual trauma, be it childhood sexual abuse, rape or repeated and threatening forms of sexual harassment. I’ve witnessed how when the assailant was known to the victim, especially someone from whom they expected comradery or even just professionalism, it can be devastating.  The fact that the assailant came from within a trusted circle often delivers the toughest ...

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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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Recently, I gave a lecture entitled, “Treating Depression in Primary Care,” at an annual conference for physician assistants.  I spent a good portion of the talk on the fundamentals that have been essential to me during my 15 years of practice.  When things go awry in mental health care, the majority of the time it is because one or more of these fundamental principles was neglected. My fear is ...

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A standard part of any psychiatric evaluation involves inquiring about a patient’s sleep.  Hidden in the answers that follow the basic question of, “How are you sleeping?” are the clues that are needed to  diagnose what is ailing the patient seeking help from me. For those with depression, they typically report early morning awakening (i.e. they wake 3-4 hours earlier than needed) and are not able to return to sleep. Those ...

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Rural America has a higher proportion of people who are at risk for mental health disorders and state offices of rural health have identified suicide, depression, anxiety disorders and lack of access to mental  healthcare, as major rural health issues.   A particularly sobering statistic is that suicide is the second leading cause of death in states with primarily rural populations. There is a shortage of mental health professionals practicing in ...

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Hidden amongst all the intense media coverage surrounding Facebook’s IPO, there was a news item that was covered so briefly that if you blinked you may have missed it: Facebook’s CEO, Mark Zuckerberg, took a trip to Japan and during this visit told Japan’s Prime Minister that the terrible Tsunami that had struck the country in 2011 had inspired him to find ways that the social network could help people ...

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It is near impossible to escape the commanding news headlines: The horrific details that are emerging about the years of violent captivity of three women in a home in Ohio; The fifteen year old Californian teenager who was allegedly sexually assaulted by three boys and then committed suicide last September. And, internationally, the tragic case of a 23 year old woman who was gang raped and beaten to ...

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