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February 21, 2017 by Sandra Steingard, MD

Farewell Mickey Nardo, 1 (not very) Boring Old Man

About five years ago, as my own blogging life was beginning, I found John M. Nardo’s outstanding blog, www.1boringoldman. His focus was on the poor quality of studies that formed the evidence base of modern psychiatry. In a painstaking way, he dove into study after study and pointed out their flaws. His outrage was apparent but couched in a graceful eloquence.

There was a comment section and I eventually jumped in. I had some communication with him outside of the blog, but mostly our communication was in the comments. At the beginning, I did not know his name or much about him. Over time, he shared a bit of his story.

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February 20, 2017 by Sandra Steingard, MD

Committed: The Battle Over Involuntary Psychiatric Care

Dinah Miller and Annette Hanson are two of the three psychiatrists who blog at Shrink Rap. After I started blogging, I began to search out other blogging psychiatrists and I found them. They also have articles published in Clinical Psychiatry News. My impression is that they are decent, well-meaning, and thoughtful psychiatrists (not unlike most of the psychiatrists I know) who want to demystify our profession. Their writing is clear, straightforward, and accessible. Like me, they are all practicing psychiatrists and they deal with the pragmatic challenges we face in our daily work. They offer critical views but they overall seem proud of their profession and their careers. While I respect their work, in that area we seem to differ; they do not seem to be burdened by the professional existential angst that besets me.

On one topic we agree — the subject of involuntary care is the most vexing, contentious, and troubling topic for psychiatry. To their great credit, they have directed an enormous amount of attention and effort to this subject in their latest book, Committed: The Battle Over Involuntary Psychiatric Care.

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February 10, 2017 by Bob Nikkel, MSW

March 8 live webinar: Open Dialogue: A Recovery-Oriented Approach to Early Episode Psychosis

Six years ago, Dr. Chris Gordon set out to train in Open Dialogue practices which had produced such good long-term outcomes for first-episode psychotic patients in Northern Finland. Dr. Gordon is medical director of the large community mental health organization Advocates Inc. in Massachusetts.  Advocates developed the first pilot project in the country, which they call the Collaborative Pathway, to adapt these methods in the United States. Advocates’ outcomes have been promising, with very high satisfaction from young people and their families, and good clinical outcomes.

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February 10, 2017 by Bonnie Kaplan, PhD

Advancing nutritional psychiatry, donors jumpstart new projects

Celebrating our achievements and setting new goals for binational Nutrition & Mental Health Research Funds

nutritionandmentalhealthfundprogress_12317The generosity of people donating to these two charitable funds is heartwarming. Both funds were established to support research in the area of nutrition and mental health, and we are beginning to do just that.

I’m so pleased to announce the following:

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February 6, 2017 by Sandra Steingard, MD

Sir Robin Murray and Our Collective Mea Culpa

Sir Robin Murray, a distinguished British professor of psychiatry, recently published a paper in Schizophrenia Bulletin titled, “Mistakes I Have Made in My Research Career.” He describes the evolution of his thinking regarding the concept of schizophrenia, including the problems with the neurodevelopmental model, the limitations of the drugs used to treat the condition, and his failure to pay adequate attention to the role of social factors in the etiology of psychotic states. These ideas are not new to anyone who has read Anatomy of an Epidemic. Sir Robin’s ’s paper could be read as a synopsis of Chapter 6, “A Paradox Revealed.”

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January 27, 2017 by Bob Nikkel, MSW

SAMHSA’s Rose-Colored Lens

The US Substance Abuse and Mental Health Services Administration (SAMHSA) should be commended for its attempt to provide a basic understanding of recovery-oriented care, and its attempt to bring recovery-oriented practice into the mainstream of professional practice.  To that end, it has produced a series of on-line training modules for peers, social workers, nurses, psychologists and psychiatrists. It has done this in collaboration with related national professional and peer organizations.

I have taken advantage of their availability recently to review them for content and to make some comparisons to what we are offering at the Mad in America Continuing Education project.  In this blog, I will share my observations and focus on the medication module developed by SAMHSA in partnership with the American Psychiatric Association and the American Association of Community Psychiatrists.

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January 9, 2017 by Bob Nikkel, MSW

Holding the Hope for New Vision at the NIMH?

It’s the beginning of a new year — and with Dr. Joshua Gordon’s ascension to the position of director at the National Institute of Mental Health, a new approach to research on mental health care.


Or not?


A quick history of the NIMH leadership over the past couple of years:  From 2002 to 2015 Dr. Tom Insel headed up this federal agency, and led the charge for finding the “real” cause of “mental illness.”  He has now moved on to Google Life Sciences (GLS) to help in their mission to develop “new technologies to transform healthcare, such as a contact lens with an embedded glucose monitor. The GLS mission is about creating technology that can help with earlier detection, better prevention, and more effective management of serious health conditions.”  Insel’s stated intention in joining Google is “to explore how this mission can be applied to mental illness.”  Giving credit where it’s due, he did acknowledge that the chemical imbalance hypothesis wasn’t going anywhere. He was also critical of the process used in developing the latest edition of the Diagnostic and Statistical Manual DSM-5.


The official announcement of the new director’s appointment last July proudly proclaimed that Dr. Gordon and his colleagues at Columbia had been studying things such as “the role of the hippocampus, a brain structure known to be important for memory and emotional processes associated with anxiety and depression.”  Dr. Gordon’s research has also analyzed neural activity in mice who supposedly carry mutations “of relevance to psychiatric disease.”  How these objects of study are analogous to mental disorders is not described, but the lab studied genetic models of “these diseases from an integrative neuroscience perspective, focused on understanding how a given disease mutation leads to a behavioral phenotype across multiple levels of analysis.” The press release lists several methods used — in vivo imaging, anesthetized and awake behavioral recordings, and optogenetics; using light to control neural activity. A gigantic leap is then made: that his research “has direct relevance to schizophrenia, anxiety disorders, and depression.”
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January 9, 2017 by Sandra Steingard, MD

Creating lives of meaning

The era when I was a young physician was one of great optimism for science and medicine. We were still riding on the advances made through the discovery of lifesaving antibiotics and the unraveling of our genetic code. We thought it was just a matter of time before most diseases would be conquered.

And that was the language, the language of war — conquering, vanquishing – that constituted our discourse. This discourse and the expectations that lay behind it entered the world of psychiatry with the notion that it was just a matter of time before we would find the genes that cause all of the problems our patients face, which in turn would lead to identification of the molecules – the drugs – that would erase their suffering.

My career began in the aura of this hope and optimism.

But there was a counter narrative, one that has deep roots in Vermont and was embedded in the growth of Howard Center during the 1980s and 1990s. It was the narrative of recovery. It was the narrative of social inclusion. It was the narrative of rights for people who had been marginalized and whose lives had been discounted. This narrative also told us that most people can recover.

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January 6, 2017 by Lauren Spiro

eCPR (Emotional CPR): A Tool & a Process of Peacemaking

It has been several years now that we have been bringing Emotional CPR (eCPR), our public health education program designed to teach laypeople to assist each other through emotional crisis, to communities across the United States and overseas. Many people have told us that the skills they have learned in our training have helped them communicate better in all their relationships. They also tell us that eCPR is a “way of life,” in that it is a practice of being more accepting of and present to ourselves and others. This is very good news, and it is an invitation to take our understanding of eCPR to a deeper level.

I had the great honor of speaking with Kofi Annan, former secretary general of the United Nations, after a talk he had given locally here in Washington, DC. We spoke about eCPR and there was a moment that I will remember for the rest of my life. He looked deep into my eyes and said, “We are in the same line of work. We are peacemakers.” It was a profound statement that inspired me to think more about eCPR as a tool of peacemaking.

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December 15, 2016 by Johann Ebenezer, MD

From poverty to purpose

The Global Mental Health Fund connects the Dhurve family and others like them in rural India with help for mental health challenges

Project “Shifa” is the Community Mental Health project at Padhar Hospital. Covering a target area of 75 tribal villages, it runs on a limited budget financed primarily by donations from well-wishers. The team consists of a psychiatrist, a coordinator, ten community field workers and nursing students posted in the psychiatry department. Patients with mental disorders and epilepsy face stigma and persecution, and often undergo painful and dangerous rituals as “cures” due to superstitions. Remote locations, poverty and lack of adequate transport facilities make access to the hospital difficult. This state of affairs is common in rural settings across the developing world, a problem compounded by the lack of trained mental health professionals.

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