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After majoring in psychology in college, I entered medical school in 1986 with a strong interest in psychiatry. While in medical school, I was exposed to the subspecialty of child psychiatry, and was very attracted to the idea of making a difference in the lives of vulnerable youth. Child Psychiatrists were experts in understanding normal development through the life cycle. This was particularly fascinating to me and I believed that it would be personally meaningful and fun to work with children. During this time, child psychiatrists often directly provided individual psychotherapy and family therapy to their patients. The use of psychotropic medications in children was not typically a first line treatment.

There is this enormous reluctance among psychiatrists, even those who clearly have begun to see the light, to take a clear, unambiguous stand against harmful interventions. So often, they settle for the old face-saving caveat – "use caution." But how can one use caution in prescribing a drug for an age group in which it has been shown to lack effectiveness and has a very high incidence of serious adverse effects? Surely the cautious approach would be not to use these drugs at all, especially since it's virtually impossible to predict which individuals will suffer adverse outcomes, including death.

Sanctuary is a hot topic.  It is applicable outside of mental health.  I am learning that many, many, many people provide Sanctuary for a time in one way or another and for a number of different reasons.  So I keep thinking about it and asking people about it, and I want to share more of what I am hearing and learning.  The topics that seem to be "on top" for me right now are support, perfectionism, structure and flexibility.

Any attempt to establish an alternative diagnostic system to the predominantly biologic DSM-5 classifications or to initiate a transformation of the individually oriented mental health treatment systems needs to critically explore how, not only what, we think about health and healing, about mental and emotional suffering, about traumatic experiences and injustices, and the multiple forms of pain that are part of our human existence. The broad critique of the DSM-5 by so many national and international organizations and individual colleagues will in the end not be powerful and far reaching enough without this inquiry into the foundations of our thinking and without reflection about our ways of thinking.