Search

Imagine that you and your traveling companion are toming the ruins of the ancient city of Pompeii. Your historically uninformed companion asks you, 'So, what caused the destruction of Pompeii?' [...]

Physician-assisted suicide (PAS)-commonly but misleadingly called 'medical aid in dying' (1)--is now legal in 11 jurisdictions in the US. PAS remains an area of great controversy among physicians, medical ethicists, [...]

There is much talk about the role of artificial intelligence (AI) in everyday life as well as in medicine. This has experts wondering: Can machines possess genuine consciousness? Are they [...]

Have you heard? The story of Paul Pelosi being attacked was fake--a false flag operation! (1) And the January 6 attack on the Capitol building? Give me a break! That [...]

The field of psychiatry has evolved and changed over the past few decades, but are those changes for the best? As an avid supporter of psychiatry, Psychiatric Times' Editor in [...]

It took only 48 hours for the pop psychology 'diagnosis' of the Uvalde, Texas, shooter to hit the internet. One headline screamed, 'A teenage psychopath is still a psychopath ...' [...]

Consider the following claim: 'Though present-day Russia poses no threat to it whatsoever, NATO is methodically and persistently expanding its military apparatus in the east of Europe and is implementing [...]

The principle commonly known as the 'Goldwater Rule' has been a part of the American Psychiatric Association's (APA's) Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry since 1973. [...]

Abstract In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined.

AbstractIn face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.

Abstract In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.

Abstract In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.

The Bible tells us to lay hands on the sick and they shall recover and will continue to do that without the fear of the spread of any virus.--Pastor Tony [...]

'Assisted Dying,' 'Medical Aid in Dying' (MAID), 'Physician Assisted Suicide'(PAS)--by whatever label we attach to it controversy continues to swirl around the practice of prescribing a lethal drug for a [...]

The man who is a pessimist before 48 knows too much; if he is an optimist after it, he knows too little. --MARK TWAIN Should Americans feel happier than they [...]

'All opinions are not equal. Some are a very great deal more robust, sophisticated and well supported in logic and argument than others.'--Douglas Adams, The Salmon of DoubtIt's hard to [...]

A little learning is a dangerous thing. Alexander Pope (1) Like the legendary Count Dracula, who could be killed only by driving a stake through his heart, some myths seem [...]

As psychiatrists, our stock-in-trade is understanding our patients' motives--and in general, understanding what makes people 'tick.' So, it may seem surprising that when it comes to mass shootings, such as [...]

Thanks to my friend and colleague, Dr Knoll, for his comments, which I find lighthearted in tone but serious in purpose. Readers may recall that Dr Knoll and I coauthored [...]

It seemed like a major statement on physician-assisted suicide (PAS) by the American Medical Association, and several media websites trumpeted the story in just such terms; for example, 'The AMA [...]

Seventeen years ago, I published a piece in Psychiatric Times[TM] titled 'The Poet and the Psychiatrist.' In the article, I alluded to 'an unusual therapy group' I co-led as a [...]

Today, the decision to prepare clinical case material for publication is a decision that cannot be taken lightly. The decision involves reviewing ethical considerations and choosing among various options to safeguard client privacy. Such options include seeking the client's permission, disguising case material, and developing composite case material. These considerations are discussed and options are described along with guidelines and a case example illustrating these points. (Contains 1 table.)

In the wake of the attack that left a Capitol policeman dead and another wounded, the individual identified as responsible reportedly told friends that he had afflictions. (1) This term, [...]

Books sometimes speak to each other in a kind of question-and-answer. My 1980s transnational quest novel, Go Home (Knut House, 2016), reclaims the xenophobic taunt and repurposes it. The opening [...]

Autonomy grew up as a street fighter, and was bloodied in some genuinely noble battles against medical paternalism. But like so many rulers ... it has quickly forgotten its democratic [...]

But given Fatic's repeated invocation of Slote's empathy-based thesis - the term "empathy" appears 29 times in his article - I still find this disclaimer a bit puzzling. Furthermore, "while it's true people with narcissism have lower empathy, I low i empathy doesn't automatically mean I no i empathy" (Raypole, 2012). Thus, a person may have a high capacity for empathy but a low degree of moral responsibility; a low capacity for empathy but a high degree of moral responsibility, and so on. To oversimplify Fatic's complex set of interlinked arguments, Fatic concludes that "emotional incompetence does not in fact reduce the moral responsibility of a narcissist person, whether diagnosed with Narcissistic Personality Disorder or not.". [Extracted from the article]

As a psychiatrist, I do not need much convincing that millions of people are suffering emotionally as a consequence of the coronavirus disease 2019 (COVID-19) pandemic. (Most of us have [...]

After what seemed like a period of relative national unity in the face of the COVID-19 pandemic, we now find wide cultural rifts emerging in the American landscape. As reported [...]

'The reward of suffering is experience.'--President Harry S. Truman. In our profession, the term psyche is usually defined as 'mind,' but the term's history and etymology are more complex. The [...]

In the wake of the horrific mass public shootings in 2019, the public dialogue turned to focus more squarely on mental illness. Many are unable to fathom how a human [...]

Come now, and let us reason together.' -Isaiah 1:18 'Reason is, and ought only to be, the slave of the passions.' --David Hume (1) After being fully vaccinated against COVID-19, [...]

Many years ago, I treated a patient who had a diagnosis of chronic schizophrenia--one of hundreds I cared for at a state mental health facility. It happened that this particular [...]

Poetry can be dangerous. Plato knew the potentially subversive power of poetry and banned poets from his authoritarian utopia, the Republic. With the exception of poetry that extolled the state, [...]