"I often say that psychiatry is two people in a room making sense of life. For some of the most important parts of my life, you have been that person for me. I can’t thank you enough. To my best friend, Nico" Just gave my first copy of the book to my best friend, a colleague. If you are interested in an honest book about psychiatry, that is willing to passionately cover therapy, meds, and honest criticism of psychiatry, I hope that you will consider reading it.

I'm surprised so few answer meth. As a forensic psychiatrist talking to people who do a lot of drugs (and have a decent amount of sex), it seems by far the #1 chemsex drug, at least in my population. TAAR1 agonism through dopamine neurons makes meth quite more potent than cocaine or MDMA. Shoutout to @AlobhaPatrick for answering “love”—the best answer.

“[Badre] wrote a massive, highly readable cutting-edge textbook called *Essential Psychopathology & Its Treatment*.” Thank you!

With respect, couldn't you say this of credulous pro-science movements? Didn’t Egar Moniz get the Nobel Prize for lobotomizing people? Didn’t Henry Cotton get called “brilliant” by the NYT for removing the organs of schizophrenics? Desperate ideologies tend toward hatred that must be recognized. It is not unique to anti-science, a subjective construct. I worry that we are often too quick to dismiss contrary perspectives.

"The American Academy of Child and Adolescent Psychiatry has silenced its own members, abandoned evidence and forfeited its reputation as an organization guided by ethical principles." @drkaliebe writing for the WSJ about the difficulty in discussing varying opinions on child gender transitions

“problems arise when professional organizations become so ideologically homogeneous that they are unable to separate their activist goals from their scientific mission” About the American Psychological Association in the WSJ today.

Dinner with psychiatrists last night. "Can you imagine a Psych News alert that read “Screening uncovers fewer people at risk than we thought”? It is always underdiagnosed. Always undertreated." This morning: “Psych News Alert: Universal Suicide Screening Uncovers Many Hidden At-Risk Patients.” This study screened 5 million: positive went from 0.7% to 3.5%. More people labeled at risk. Did that help them or anyone, who knows? I once predicted that hospitals would start doing multiple suicide risk assessments a day. That is now the norm with records I review.

Who could have predicted that a new treatment in psychiatry overpromised and underdelivered? Some were telling me that withholding SAINT TMS was unethical. While I am a fan of short and time-limited interventions, we should learn to moderate our enthusiasm.

Are we proud of the first two?

AI for mental health? We have already replaced interviews with impersonal scales. We also have impersonal medication algorithms. Some even do “collaborative care” where we don’t see the patient at all. The next dystopian step is to take the humans out entirely? What if a core problem was loneliness? Not being seen, heard, or understood. AI can be endlessly agreeable, but that is not the same as being understood. An agreeable AI actually confirms the belief that withdrawing from people is the solution. If the suffering is not being seen, the treatment cannot be something that can’t see you.

Clancy “had no memory of what happened”? That’s what Reddington argued today. If she woke in the hospital with no recollection, how does she later tell forensic psychiatrists she heard a voice saying, “This is your last chance. You have to kill your kids and then kill yourself”?

My latest in Psychiatric Times: courts are using “brain science” to argue that responsibility does not start until 25. I am not convinced the science says that. 1. If you claim a brain defect, show it in the individual. 2. Group averages do not describe the defendant in the room. 3. Most of the change in executive function is already in by 18. 4. The brain changes at every age. Used that way, the argument would exculpate everyone. 5. Moral understanding comes in well before 18. I believe in mental illness. I believe in diminished capacity when it is actually there. If everything is mental illness, nothing is. We should examine the person in front of us instead of relying on scientific sounding mumbo-jumbo. psychiatrictimes.com/view/ex…

Are we adults at 18? Courts are repeatedly told by colleagues of mine that people under 25 are impulsive and cannot make decisions for themselves. The claim is dressed up as neuroscience. What is usually missing is an examination of the actual person. A few years ago I wrote about the same problem with PTSD. This is the next one. My latest in @PsychTimes: psychiatrictimes.com/view/ex…

Andrew Scull is one of the most important historians of psychiatry. A must-listen podcast for those interested in mental health. His book, Desperate Remedies, is essential to understand psychiatry.

Overdose deaths have fallen from the COVID-era, but the rate is still higher than it was before the fentanyl epidemic (~15 per 100,000) and more than three times the 1999 levels.

"Anyone selling you anything better than ‘highly imperfect’ in the realm of mental healthcare is a fool or a grifter." Excellent piece by Awais about our need for humility when faced with the complexity of human suffering.