Any jerk can prescribe medicine; the real art & science is knowing how to deprescribe.

Darwin had 2 best insights in history of psychiatry: 1)Our behaviors are inherited from animal ancestors 2)Our motivations are mostly unconscious. Evolutionary psychiatry still best way to understand normal & abnormal behavior. 2 great free articles at: onlinelibrary.wiley.com/toc/20515545/2…

To avoid DSM reification/stigma: No patient "has schizophrenia" or "is schizophrenic"- lazy/misleading/reductionistic terms Proper usage: Patient "meets criteria for schizophrenia" Why? Mental disorders are constructs- not diseases People are so much more than their disorder

"Kintsugi" is another Japenese spiritual inspiration for patients. Art form that repairs broken pottery with gold- highlights rather than hides the cracks. Beautiful metaphor demonstrating that beauty can be found in imperfection. Patients among very best people I've known.

Anti-psychiatry "philosophers" who deny importance of psychiatric diagnosis have in common a lack of common sense & clinical experience. Psych labels are certainly limited/fallible/subject to bad misuse- but they remain essential in understanding & properly treating patients.

We're drowning in scientific hype/studies that rarely replicate. Gotten so rotten I now fully believe only negative findings. Publication Bias: 1)favors exciting false to banal true 2)distorts scientific enterprise Read great thread on 'lithium/suicide' exposing this failure:

Up til now, I've argued Trump is evil- not mentally ill. But latest rants go far beyond usual lies- suggest he's out of control/lost touch with reality. This makes him doubly dangerous/completely unpredictable. Great summary by Heather Cox Richardson: heathercoxrichardson.substack.com/p/september-7-…

'Psychological Resilience' reduces morbidity/mortality of both med & psych illness. All clinicians should promote in all patients during every visit: 1)Instill realistic hope 2)Reverse demoralization 3)Good minutes each day 4)Exercise 5)Nature My take from this important study:

I've watched Trump act like an absolute idiot for 50 years. But Trump's rants on tonight's debate are far nuttier & far more incoherent than ever before. If he is King Lear now, what will he be like in 4 yrs? Suggests there should be age limits for presidential candidates.

Crucial task in psychiatry is judging risk of suicide & violence. Problem is both are rare event needles in haystacks. Easy to pick out high risk groups/impossible to pick out who & when. Dozens of scales help clinical judgment/will inform AI- but all have high false + rates.

"Pathologizing grief is an insult to the dignity of loving relationships, proclaims grievers as mentally ill and will too often result in the careless prescription of antidepressants/other drugs" 🎯Joanne Cacciatoreⓥ Allen Frances thelancet.com/pdfs/journals/…

Providing mental health services for kids in schools is a wonderful idea in theory- but it's largely a flop in practice. Programs divert very scarce resources away from the kids who most desperately need them. Here is best summary of issues & evidence: manhattan.institute/article/school…

There's an enormous difference between Trump now & Trump in 2016. Then Trump was pure evil- now he is both evil & deranged. A much more dangerous & combustible combination.

"Evil" Synonyms: bad/corrupt/immoral/base/heinous/nefarious/iniquitous/rogue/malicious/malevolent/wicked/depraved/villainous/monstrous/criminal/noxious/vile/offensive/nasty/noxious Til recently, "evil" described Trump better than psych jargon. Now likely he's also "deranged".

Very few evil people are mentally ill; very few mentally ill are evil. Trump has been evil all his life; now seems to be losing it cognitively & losing touch with reality. But we can't be complacent- it's still close race & some possibility Trump is still "crazy like a fox".

ICD-11 made a dumb mistake legitimizing "Compulsive Sexual Behaviour" as official 'mental disorder'. See below why such awful idea to medicalize immorality & criminality- stigmatizes mental illness/gives bad guys fake excuse. This was 1 mistake DSM5 avoided- made many others:

Too good to be true but true: 'WORLD PSYCHIATRY' (best mental health journal) is completely free & easy to access. Please share the availability of this great resource with your colleagues. You can click on to October 2024 issue & all back issues here: ncbi.nlm.nih.gov/pmc/journals/2…

1st met Awais Aftab when he was psych resident- could tell in 30 minutes he'd be a star. He does piercing interviews of leaders in field who disagree on most things- & captures what's most useful from each. Book is an intellectual adventure with crucial clinical consequences:

A special shoutout to Allen Frances in the preface of the book:

Clinical depression is so different & worse than sadness, most people can't empathize with someone suffering from it x.com/ptsdjedi/statu…