Does Severe Remorse Require a Specialist?

There are few resources specifically for "accidental killers." Can people with severe or unusual emotional suffering get help from mainstream sources?

Lumping and Splitting: Balancing Connection and Safety

We live in an age of political splitting. From left to right, differences are highlighted, commonalities submerged. Individual and cultural health instead demands a balance.

The "High-Risk" Psychiatric Patient

In medicine and surgery, a "high risk case" means the patient is at risk. In mental health, sometimes it's the doctor.

Psychodynamically Informed Clinical Work

A psychodynamic perspective can enhance and individualize non-analytic treatment — even "med checks."

Diagnosing Donald Trump

What does psychiatric diagnosis add to political criticism of President Trump?

A Christmas 2016 Fable

The story of Rudy, and how his boss helped him gain acceptance by his coworkers.

Prescription Drug Abuse and the Physician Gatekeeper

Many medications can be abused. Prescribing doctors are gatekeepers who separate legitimate use from abuse. However, this distinction is becoming less clear.

Is the DSM Clinically Useful?

Psychiatry's "Diagnostic and Statistical Manual" serves many functions. Surprisingly, the routine practice of clinical psychiatry isn't one of them.

Dilemmas of Cash-Based Practice

There is a growing movement for primary-care doctors to avoid insurance and only accept cash. Psychiatrists have been there first. What lessons can we pass along?

Choose Your Actions, Not Your Feelings

Blaming ourselves (and others) for emotions isn't fair.


One-upmanship is staying a step ahead of rivals by showing superiority. The converse is gaining an edge by appearing weak, inferior, or victimized. It's trickier but quite common.

Are Psychiatric Disorders Brain Diseases?

Prominent psychiatrists declare that all mental disorders are biological diseases. Is there proof? If not, can they say it anyway?


We each find a comfort zone between the poles of paranoia and gullibility, and proudly defend our spot at the expense of adaptive flexibility.

Hiring the One-Armed Surgeon

Working with an impaired psychotherapist is like hiring a surgeon with one arm.

We Are All Fallible Experts

Our ability to abstract, infer, and categorize is a gift. But it's also the root of prejudice and stereotyping.

Medical Professionalism Vs Commercialism

The physicians' guild may have been paternalistic and self-serving, but it also stood for high quality medical care. Will patient care suffer as commercialism and populism take its place?

Medical "Disruptors" as Adolescents

Entrepreneurs with "disruptive" business models are driven idealists and rebels, impatient with current practice. In this way they are like adolescents. Our future is in their hands, but they need guidance.

Medical Ethics Are Healthier Than Business Ethics

Traditional medical ethics puts patient welfare first. As corporations increasingly control health care, business ethics replace medical ethics. Doctors and patients must work together to defend the doctor-patient relationship.

America's Top Selling Drug

There’s nearly no end to the money the U.S. health care system will spend on problems that can be addressed more economically.

Behavioral Science Versus Moral Judgment

Learning more about the mind clashes with simple descriptions of personality. But our moral judgments of others won't surrender without a fight.

Defining the Competent Psychiatrist

What is a competent psychiatrist? Harsh critics declare the question moot, official bodies print long lists of "competencies." Is the answer in between? What does it take to understand and help troubled people?

Living Between Three and Seven

This simple numerical scale helps put feelings in perspective, and illustrates how cognitive and dynamic approaches can complement one another in therapy.

A Brief History of Psychiatry

Psychiatry can be neither "brainless" nor "mindless." Unfortunately it has tended to be one or the other for much of its history. Can we go beyond choosing sides?

Between Medical Paternalism and Servility

Excessively paternalistic doctors are reviled by many patients today. But is a servile physician better? By avoiding both extremes doctors may demean neither their patients nor themselves — and in the process deliver the best healthcare.

OpenNotes: Good Intentions Gone Awry

OpenNotes is a national initiative to let patients view their doctors' notes online. Advocates say it improves collaboration, gives patients more control of their care, and can correct factual errors in the record. Doctors and patients who use it say they like it. So why it is a bad idea?

Military Brain-Chips to Cure Psychiatric Disorders?

DARPA, the people who brought you the internet, now want to implant chips in the brains of psychiatric patients. This isn't science fiction, it's well-funded research. What are the potential risks and benefits of this high-stakes venture?

Enjoying Clinical Uncertainty

Psychiatrists (and primary care doctors, e.g., family practitioners) face diagnostic and treatment uncertainty every day. What separates those who merely tolerate this uncertainty, from those who welcome and even enjoy it?

Psychiatric Uncertainty and the Neurobiological Buzzword

Psychiatry has embraced neurobiological research, a promising area for discovery. Unfortunately, the term itself has become a buzzword, falsely implying we know the etiology (cause) of psychiatric disorders. Instead of overreaching rhetoric, the field should embrace the uncertainty that has always characterized psychiatry.

My Goal as a Therapist: To Make Myself Obsolete

Traditional therapy is often caricatured as endless, with a complacent therapist silently growing cobwebs, listening to a patient who never plans to leave. Our aim, instead, should be to make ourselves obsolete.


What does it mean to be "undermedicated"? The term hides a few dubious assumptions.