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).

ï»żNews Roundup From June

There are a number of bloggers that regularly send out news of the latest findings reported in psychiatric journals and other media, and I...

Ghostwriting: Time for a Name Change

There is a fascinating process playing out in academic medicine right now. The general public is understandably concerned that much of the medical literature...

Real Psychiatry and Darwinian Evolution are One and the Same: Molecular Psychiatry has Missed...

The basic principle for the development of human personality is the very same as for Darwinian evolution. In our quest to understand human biology, we have lost our way. We are looking in all the wrong places. The human organism from the beginning adapts to its salient environment. We can trace our adaptations from a zygote, to an embryo, to a fetus, to a newborn, a baby, a toddler, a child, an adolescent, all the way to adulthood. This also tells us how psychiatric problems arise, and informs us of the appropriate and effective treatment.

Better Living through Chemistry?

Reading the article “Risky rise of good-grade pill” in the New York Times on Saturday once again raised the philosophical issue of how to...

ï»żSeptember 18, 2010

Dear Robert, I just finished Anatomy of an Epidemic while on vacation. I am a family physician (and writer) practicing in Colorado.  For years, my practice...

ï»żA Rorschach Test for Psych Drugs

On October 23, the New York Times ran a very nice feature story about a Los Angeles woman, Keris Myrick, who, even though she...

Letters from the Front Lines

I saw a patient recently, a 35 year-old woman who needed a refill of her Zoloft.  She been started on it four years prior,...

A New Model of Service

What should the relational and emotional stance of the therapist be? Just who exactly is the therapist in relationship to the person coming to see the therapist? What is the therapist's job, exactly? What should the therapist's disposition be toward the person sitting across from them? What kinds of assumptions or presumed power come with the label therapist and are those assumptions harmful or helpful?

How Can We Stop So Great an Injustice?

I don't normally post items so close together but today NAMI Ohio has successfully convinced a State Senator to sponsor a bill that I...

ï»żSumming Up the NIMH Trials: Evidence of an Effective Paradigm of Care?

In the past 15 years, the NIMH has funded a number of major, multicenter trials of drug treatments for mental disorders in adults and...

Doctor Munchausen and Sense about Science

In June this year the BMJ published an article supposedly about how the Black Box Warning that antidepressants cause suicide had led to a drop in the use of the same antidepressants and an increase in suicides. The message was widely trumpeted in daily newspapers and other news outlets as well as the press office of Harvard University and the American Foundation for Suicide Prevention. In fact there had been no drop in the use of antidepressants and no increase in suicide rates or suicide act rates. The letters sent to the BMJ in response to the article wondering how such a shoddy piece of work could possibly have been published are worth reading – rarely is academic contempt so scathing.

ï»żSeptember 27, 2010

Bob-- I would guess that as I am typing this, you are in the midst of a spirited defense of your book at the conference....

ï»żNovember 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...


The movement to radically reform the modern mental health system is rooted in a desire to offer people going through emotional distress a wider variety of options for care. As a society we have largely shifted to a model of care that is limited to a select few options that primarily advocates the use of strong psychotropic drugs and simplistic diagnostic labels for complex and widely varying narratives. The stigma of going on an antidepressant has been lessened to such a degree that one out of nine people in the US now takes this class of drug. In the context of this astronomical growth in drug-based therapy, reformers are rightly calling for a dramatic reappraisal of how we are treating emotional distress.

Robert Whitaker: Looking Back and Looking Ahead

On March 5, Bruce Levine, PhD, published an interesting article on Mad in America  titled Psychiatry Now Admits It's Been Wrong in Big Ways – But Can It Change? Bruce had interviewed Robert Whitaker, and notes that Robert, in his book Mad in America, had challenged some fundamental tenets of psychiatry, including the validity of its "diagnoses" and the efficacy (especially the long-term efficacy) of its treatments. Bruce reminds us that Robert initially incurred a good deal of psychiatric wrath in this regard, but also points out that some members of the psychiatric establishment are beginning to express a measure of agreement with these deviations from long-held psychiatric orthodoxy.

ï»żJune 17, 2011

Bob-- Here is a letter that I wrote several months ago in response to an early reader of my blog here. She expressed concern about...

Outside the Bubble and Into the “New” Economy

A recent report from the Bazelon Center for Mental Health Law on "Promoting Employment of People with Mental Illness" provided the same dreary picture that those of us working in mental health systems are familiar with: that people labeled with mental disorders are employed at a much lower rate than their non-disabled peers. The report calls for broader implementation of the evidence-based practice Supported Employment, which is scarcely available to any individuals across the nation served by public mental health systems which favor funding of other behavioral health services.

Clipping Care, Not Profit

Right now in Britain there is a controversy shaping up between the commercial and financial interests of big managed-care corporations and the need to care for vulnerable people in the community, people with conditions like dementia and long-term psychoses. Conflicts of interest are nothing new in the contested field of mental health, but this one threatens not only quality of care, but the well-being of low paid workers, mainly women, who are employed as support workers.

Grief, Peace; Not Profiling

Like everyone else, I was shocked and stunned by the senseless mass killing of young children and adults in Newtown, Connecticut. The families and community deserve their chance to mourn and search for their own meaning and healing. However, I cannot be silent about the threats now being made against my community, as people respond to this act of terrible violence. The aggressive legislation against people labeled with psychiatric diagnoses that is being promoted by the NRA and by Representative Sensenbrenner, among others, is not a fit way to honor anyone's life.

Letters from the Front Lines

Dear Bob-- I met a new patient today, an African American gentleman in his late 40's, a successful entrepreneur and innovator (invented and marketed his...

The Pond, Learning and Humility

What an amazing ride I’ve had in the past few days on the tsunami of commentary from my previous post. While it’s been fun (dare...

Persecution: Dangerous Liaisons

From 1951, a system designed for heroin and cocaine addicts – prescription-only status – was applied to all new drugs. Why? These were after all the first truly effective drugs in medicine. But the ability to do good came with a likelihood of doing harm. There was a trade-off to be made between risks and benefits. The new complex trade-offs could not be put on to the label of a drug or even captured in a forty page package insert. They needed to be individual to each person.

West Virginia’s Prescription Drug Abuse Problem: Intersection of Two Industries?

The line between legal and illicit, "addictive" vs. "necessary", becomes vanishingly thin when it comes to the medications prescribed in areas of the country that are being stripped of their natural resources. The mechanisms of science, medicine and our government that were once thought to protect and serve are instead leaving residents on a trail of pain, addiction, dependence and poverty produced by the intersection of two highly profitable industries. (Editor's note)

ï»żOctober 14, 2010

Bob-- Had two very interesting cases this morning: First, I saw new patient, a very thoughtful, intelligent retired pastor who is on Citalopram. We were visiting...

One Script to Rule Them All

The marketing departments of pharmaceutical companies focus in on the ring-bearers just as the Eye of Sauron focused in on Gollum and later Frodo. Once the Eye fixes on a ring-bearer, it hypnotizes him into submission. If any demur, it directs its Black Riders (Medical Academics) to enforce compliance with its Will.