I thought I would review a book sent to me by a friend who I emailed about the concept of suffering. At issue was whether suffering was useful or not. That issue was used as a social media cudgel against psychiatrists – specifically that psychiatrists are trained to alleviate suffering but if they did not people would benefit from it instead. That is obviously an overly simplistic argument by a person who does not know very much about psychiatric practice.  I don’t want to get too far afield from the actual book. The author is Sylvain Tesson who is generally described as a world ..read more

  In addition to the clinical work – psychiatrists need to have their finger on the pulse of popular culture.  Not just the content – but the process of it all.  How else can you talk with a young patient who is describing their experience of a rock and roll lyric and what it means for their life?  Or patients who are caught up in the latest cultural movements – whether they are useful or not.  Sports of course are a big part of the culture and in the last few months there has been no bigger sports phenomenon than Caitlin Clark of the Iowa Hawkeyes basketball team.&nb ..read more

    Receiving a novel to review this morning reminded me that I should probably comment on that process.  I am very grateful to any authors, editors, or publishers who send papers, books, and book chapters my way.  I have a rigorous reading schedule – especially post-retirement.  Scientific papers are my top priority and I generally read 4 or 5 a day.  That number can go way up if I am working on a specific blog post that requires it. I rarely read fiction but it all depends on what I am focused on.  For example, the question of suffering came up and I am ..read more

  I finished my second MRI scan this year earlier this afternoon. So far lifetime – I have had 5 and will have 6 by the end of next month.  I am sure that many people reading this have had the experience and I would not rate it as pleasant at all.  Just the obsessive checklist that must be completed prior to the scan is enough to raise the anxiety level. Is my body free of implanted or tattooed or accidentally placed metals?  When they were scanning my pancreas – my first thought was: “What about that laparoscopic cholecystectomy I had done in 2015?”  I had read the o ..read more

Depression is a significant cause of disability in the world.  That is complicated by the fact that there are not enough resources to treat people with depression, access is rationed in many areas including the United States, there is a high rate of attrition during treatment, and depression is often associated with significant medical and neurological disability further restricting access to adequate care.  Over the past 30 years, strategies for treating depression have increased considerably since antidepressants medications are not uniformly effective and they have side effects ..read more

  Last night around midnight – I noticed that I had crossed the 2 million reads mark on this blog.  The Google Blogger interface that I use is not very granular so it is difficult to tell how many of those hits are actual reads as opposed to something else. By something else I mean hackers, bots, and people trying to use my blog for free advertising.  The products are typically illegal or barely legal drugs or psychiatric services outside of the US.  The increase in VPNs is also probably a factor.  Over the years the number of hits per page has flattened out while the ..read more

    I was notified this morning that a letter I sent in to the New England Journal of Medicine would not be published because they had limited space.  Anyone sending a letter is notified that if the letter does not respond to one of their articles you are limited to 400 words.  If your letter does respond to an article the word limit is 200 words.  I was responding to an essay by Lisa Rosenbaum, MD (1) and whether medicine is a calling or just a vocation and the implications that each of those categories have.   My first attempt at the 400-word mark (374 a ..read more

  Kenneth Kendler, MD needs no introduction to anyone even vaguely familiar with the psychiatric literature.  If you need to do your own research his accomplishments and scientific papers are widely available on the Internet. This post is to focus on his recent commentary in JAMA psychiatry (1) over the issue of psychiatric diseases and whether or not they are brain diseases.  He starts out with a 1867 quote from Griesinger stating that the brain is the only logical origin for symptoms of insanity. His analysis is at the level of “pathological and physiological” factors. He b ..read more

    Pattern matching is an important skill for all physicians.  It is rarely discussed these days despite all the continuous hype about artificial intelligence replacing doctors by reading x-rays and other lab tests.  I taught a course in diagnostic reasoning for about 12 years and the examples of pattern matching I used were from dermatology and ophthalmology.   The dermatology experiment was a straightforward comparison of dermatologists to primary care physicians looking at the same slide set of rashes and skin lesions (1).  The dermatologists were correc ..read more

  I happened across this old post on approaching retirement today and reread it. Of course, I am biased but it holds up well.  It contains information about psychiatrists retiring that you will not see anywhere else – including why we are happy.  I currently spend much of my day doing the usual chores, exercising, and writing.  I have several writing projects going and am near completing one that is unique. I don’t get out much and I like it that way. I am an introvert and have been subjected to the usual jokes about introversion.  The pandemic was a factor but not t ..read more