Monday, May 27, 2019


Essays by a diverse group of writers, in the United States and abroad, engaged in rethinking psychiatry. (The directory of personal stories can be found here, and initiatives here).

New Study on a Non-Toxic Intervention for Those at High Risk of Psychosis

A new multi-centered study was released about using cognitive therapy for young people who were seen as being at high risk of psychosis. The article reporting the study is on the British Medical Journal website, available in full – It’s curious to see how it is being reported in the press.

The Relationship Between Systems Change and Being Present with Others

Despite the hiring of peers, the mental health system still has not implemented the recovery and trauma-informed values advocated by both SAMHSA and by people with the lived experience of mental health recovery. Person-centered planning requires a system-wide shift in communication, as well as adaptation of recovery-oriented, trauma-informed values. Tomorrow, Dan Fisher, W. Reid Smithdeal and I are offering a webinar that will provide administrators, managers, providers of mental health services and others with some essential communication tools needed to transform their systems to being recovery-based, trauma-informed and empowerment focused.

22 Human Rights Defenders Tell Senate: Ratify Disability Rights Treaty Without Limitations

Psychiatric survivors know that U.S. law does not protect our rights under the CRPD and needs to be changed; it is also contrary to human rights principles for any country to assert that its own law represents the limit of its treaty obligations.

Introducing Myself

I’m an Associate Professor at the Georgia State University in the School of Social Work. Early in my career in the late 1960s and...

Letters from the Front Lines

Bob-- An encounter from this week: I saw a 24 year-old theater actress who was started on Lexapro nine months ago for a one-time "panic attack"...

Developing Policies and Practices for Medication Optimization

Southern Oregon physicians—from family practice specialists to psychiatrists—and nurse practitioners, social workers and other mental health professionals have been meeting for several months to...

Legislators: Don’t try to sneak this through as an amendment. (HB1386)

Your next move will be an amendment to another measure. Do not attempt. You've pulled bogus crap with this since the beginning. You've lied about task force recommendations. You've pulled suprise buttsex scheduling, when proponents somehow got the message, and opponents were left scrambling to get there. Twice. You basically filibustered us on Wednesday, which was also scheduled without notice.

Letters From the Front Lines

Dear Bob-- A disturbing case from this week. I was working at an urgent care and saw a fifteen-year old boy for the complaint of severe...

November 26, 2010

Bob-- Very interesting case today, a forty-six year-old woman, new patient, overweight, and very pleasant. She is someone who, at first glance, I never would...

In Praise of Families

This anecdote is offered as a story in praise of families and a recognition of their importance to the process of recovery.

December 15, 2010

Bob-- I saw a thirty-four year old woman today for a follow-up visit regarding post-partum depression. She delivered her second child two months ago, and...

January 31, 2011

Bob-- Today, I saw an intelligent and sarcastic teenage boy for renewal of his Adderall. He presented with his well-meaning but frustrated father, who is...

People With No Alternative Say What They Have Is OK

Four out of five adults, youth, and family members of community mental health centers (CMHCs) in New Hampshire told researchers they are satisfied.  Three...

November 4, 2010

Bob-- Today, I saw a healthy, strapping young man, 28 years old and an avid recreational softball player. He is a former college athlete and...

The Empire of Humbug: Bad Pharma

Some psychiatric drugs are extraordinarily effective, for instance benzodiazepines for catatonia or SSRIs for premature ejaculation. These treatments are so effective that controlled trials are an irrelevance. Every trial conducted would show a positive result. The point here is not that it is impossible for a treatment to achieve effectiveness but rather that controlled trials have little useful to contribute to the issue of effectiveness. Randomized placebo controlled trials have not shown any drug within the mental health domain is effective. If a treatment were effective virtually every RCT undertaken would show a positive result.

Extreme States and the Power of Journeying with the Other

I recall working with a young man who had undergone sexual trauma at the age of 4. He lived in a chaotic family with...

January 17, 2011

Bob-- About a month ago, I started caring for a fifty-five year old Filipino woman. She speaks English well, though with a heavy accent. She...

April 30, 2011

Bob-- I have found that many patients, and even many physicians, don't appreciate the basic differences between psychology and psychiatry. For most of your readers,...

Doctors Need Support

An old friend suggested to me that doctors need support after hearing the messages in Robert Whitaker’s book, “Anatomy of an Epidemic”. I agree....

June 27, 2011

Dear Bob-- I have been working again, taking temporary assignments filling in for other physicians and working in urgent cares while I get my practice...

Volunteers for Psychotherapy Is A Finalist for International Award

Volunteers for Psychotherapy, which is located in Hartford, Connecticut, and has for years run an innovative program that gets clients involved in community programs,...

Mental Health Homes Open Their Proverbial Doors in New York: Caveats, Part II

Given the length of this blog and the subject matter it addresses, I’ve divided it into two parts. Part II appears immediately below, Part...

November 1, 2010

Bob-- Since we've started posting these letters, I've had a number of readers responding to me and asking about my strategies for withdrawal. As you...

Better Broadband

So many treatment colleagues have shared that prior to finding an approach that really works to turn a child’s intensity to greatness, they felt no recourse other that to look for ways to moderate the accelerating poor choices that children they worked with were making. Most relevant here is, that in retrospect, they felt that it boiled down to simply being faithful to their training, which it turns out so often is a set up to fail with difficult children.

Peace Making

Many of us feel at a loss to fight back against the tidal wave of negative opinion against us. We are wasting our breath arguing that the vast majority of us never commit acts of violence, that the medical model fails everyone and coercion drives people away, etc.

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