Reflections on Psychiatry, Therapy, and Mental Health

an idiot's guide to AA It’s easy to feel like an idiot when confronted with something entirely new and perhaps intimidating, especially when that newness also involves a social movement with a long history and established culture. The reality, though, is that if a person is considering giving AA a try, they are far from being an idiot. Full disclosure: I am a psychiatrist and addiction specialist, thought not a member of AA I have had a chance to attend some very robust meeti

Recently I ran across a YouTube video by a sleep expert who suggested a little exercise that might be helpful for middle-of-the-night wakers. He suggested remaining relaxed and randomly picking letters from the alphabet then doing a little word association thinking of words that begin with the chosen letter. One night I gave this a try and noticed that in my relaxed state I tended to personalize a fair amount of the words. 'C,' for example lead to: Cape Cod, Catholic, Cari

Those of us in the profession of therapy know that we practice an art, yet live with the fact that our art is practiced in private and so is rarely if ever displayed to the public. This is not pleasant as artists have a natural tendency to want to share their work. Yet, if one views the third episode in the series, 'Adolescence,' one will be a fly on the wall, watching two actors create a very genuine and deep portrayal of what a good therapeutic session is like. The setup

AI generated image of a student and humanistic mentor Don't get me wrong. I have a high respect for science and evidenced based contributions to our clinical work. On the other hand, too often have I run across clinicians who are cynical to those of us who work in the domaine of psychotherapy and related approaches to helping others that are difficult to pin down with scientific methods. Consider the framework of possible pushback should you run across an uber-scientist. G

I've always been bothered when patients view the value of their sessions with me in terms of time spent, rather than quality of experience. This happens most often with patients who are seeing me for med checks and are getting the counseling through another clinician. The other day this happened. My administrator came into the office after a patient visit reporting a complaint, 'the doctor only saw me for 15 minutes and the appointments are so expensive.' I knew that an

How therapists make ethical choices in both in-person and telehealth care—balancing harm, autonomy, privacy, and the risk of self-indulgence. I enjoyed a good conversation the other night on ethics as it applies to mental health treatment. As often happens after a good exchange, I came away from it wanting to enrich my understanding of some of the issues we talked about. Saul Bellow once said, 'how can I know what I think until I see what I write?' With this in mind, here'

Hwy 321 is a very pleasant drive connecting the college town of Boone NC with the resort area known as Blowing Rock. Just outside of Blowing Rock travelers will find a theme park that has been around for decades. The 'House on Mystery Hill' is a remarkable little structure wherein, it is promised, visitors will experience a mystery force. Per the theme park's website: Explore our mysterious Natural Gravitational Anomaly  and watch a ball roll upwards and water flow uphill! Th

Sonia Hsieh and I had the recent opportunity to record a little podcast on psychedelics. I come from traditional psychiatry with an interest fueled by the recent approval of Ketamine with a great appreciation for its therapeutic promise and demonstrated benefit to patients in our clinic. Sonia brings to the conversation a lot of experience as a guide and a deep perspective, based on observational experience and study, as to the potential of these drugs. We hope our podcas

Zooming the last supper Can you all hear me? I'm sure many therapists have been thinking about the clinical subtleties entailed in doing virtual therapy. I have been doing almost 100 percent virtual sessions now for well over a year. A few months ago I would have said that screen visits do a pretty good job of simulating being in the room with a person. Now I am not so sure. As I move back into the office with more face to face interactions, I am finding the contrast enl

In light of the pandemic and attitudes towards vaccines, I've been thinking a lot about conspiracy theories. As a child I remember being amused looking at instances of the 'National Enquirer' on the news rack as I trailed behind my mother in line to pay for our groceries. The front page seemed so innocent, a picture of a celebrity freshly returned from an alien spaceship, or, perhaps a celebrity hiding her two headed baby from the public, only to have her secret splashed on

We made a little 9 minute podcast on the phenomenon of presentism and a bit of the biology behind it. Let's hope this quirky image gets you curious.

yes we fought, but we very much respect our relationship. Here the loser raises the hand of the winner. We mental health clinicians know that we should be cautious in giving advice, we respect our patients for their differences as well as their autonomy. Nevertheless, there's plenty of room for advice when it is offered in a thoughtful way. I suggest that the best advice we give patients are concepts, not decisions. Conceptual advice serves as a container within which a pe

from diagnosis to poetry I almost never hear the word neurotic these days in the conversations and writings of mental health professionals. Quite a paradox in that neurosis is all about me observed both in myself and in my friends, not to mention patients. Neurosis is nothing more than being at odds with oneself. The spectrum of neurosis is a continuum from harmless and amusing to disabling. I'm not sure why the concept of neurosis has been neglected, but I'd guess it ha

Most of us heard the story of Narcissus in our childhood: he falls in love with his reflected image, and becomes so fixated that he eventually tumbles into the water and drowns. Children get the message of the fable; Narcissus is foolish, as foolish as the three little pigs, or the emperor without clothes, all of whom we readily saw through, even as children. Healthy Narcissism and Psychological Development The term Narcissism, however, is maligned. While I make this complai

Let's take an excursion and relate an aspect of a television screen to some deep issues in psychology and mental health. A TV screen consists of no more than tiny dots of red, green, and blue. These pixels are so tiny that you don't see them as such, what you see is a picture with a broad spectrum of colors and hues. The three pixel colors: red, green, blue are dimensions of the TV's image, yet combined, you are treated to a wonderful breath of experience. Contributing to

The two gentlemen above are under stress. They are also in a fair amount of pain but if you were to ask, they would tell you that they are enjoying themselves. It's a curious fact that we humans feel offended when stress is imposed on us, but at the same time we welcome stress in the form of challenges and competition. It is stunning to learn that we Americans, some 5 percent of the worlds population, consume 80 percent of the world's opiates. We hardly suffer more than ot

The little fellow above is an American Caesar Mushroom that I met in the forest before the pandemic started. She is considered a choice edible, and often is consumed raw with a little olive oil and balsamic. Even more striking than her taste is her beauty. I was attracted to the forest because of mushrooms, but once in the forest and familiar with its ambience, I began to hear people refer to forest wandering as, 'forest bathing,' and I began to realize that I was not the

Future discounting, also often referred to as temporal discounting, is a curious behavior in which all of us to a degree value a thing in the present more than that very same thing when access to it is delayed. For example, if I offer you 100 dollars now, and promise that if you hold of I'll giv you 150 dollars in a week, how much is the 150 worth to you at the moment you are making the decision between the two. It has been consistently observed that people with addictive pr

A Website has the obvious role of attracting attention to one's business. We certainly want to do that, but more importantly we also want this to be a place where we reveal our identity to the public. All too often clinicians are thought of as faceless commodities that end up on some insurance company's list of providers. As a patient, I would not seek help that way anymore than I'd want to buy a work of art sight unseen. This is an upgrade of an old website that ended up