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Ethical Dilemmas Of Psychiatry: Should Confidentiality Ever Be Breached?

I’ve been asked several ‘ethical dilemmas’ in the past few weeks.  I’m putting them up on Shrink Rap, but please don’t get hung up on the details.  These aren’t my patients, but the details of the stories are being distorted to disguise those involved.  The question, in both cases, boils down to: Should the mental health professional report the patient to his professional board?

In the first case, a psychiatrist is treating a nurse who is behaving badly.  The nurse is stealing controlled substances from the hospital and giving them to friends who ‘need’ them.  She doesn’t intend to stop, and her contact with the psychiatrist was only for an appointment or two before she ended treatment.  Should the psychiatrist contact the state’s nursing board?   Is he even allowed to?

In the second case, Read more »

*This blog post was originally published at Shrink Rap*

Does Your Therapist Think You’re A Narcissist?

Psychotherapy is, by it’s nature, a narcissistic endeavor.  That’s not to say that the patient is a narcissist, but the journey itself is meant to focus on patient’s interior life, and it’s not always about the greater good.  In my last post, several commenters said they feel uncomfortable talking about themselves or worry that their therapist will mistakenly think they are narcissistic because they talk about themselves in therapy.

It’s not at all unusual for people to express some discomfort about talking about themselves in therapy, or to comment, “all I do in here is complain,”  or “You must get tired of hearing people complain/talk about their problems, etc….”

I won’t talk for other psychotherapists because I only know how I feel.  It seems to me that the mandate of therapy is for the patient to talk about the things they have been thinking about.  The truth is that most people think about themselves, and issues of the world are interpreted by individuals as they impact them.  Some people Read more »

*This blog post was originally published at Shrink Rap*

Therapy Is About Having An Honest Relationship, But Is Lying Ever OK?

We’ve been having a great discussion over on the post Tell Me…. An Ethical Dilemma.  The post talks about a young man who wants to know if he can check “no” to a question about whether he has a psychiatric disorder if his illness is not relevant to the situation.  The comments have been fascinating — do read them– and very thought-provoking.

One reader asked, ” If a patient asked if they were boring you, and they were, would you say yes?”

This is a great question, and of course the right thing to do is to explore with the patient what meaning the concern has to him.  But is that all?  I’m not very good at doing the old psychoanalyst thing of deflecting all questions, and mostly I do answer questions when they are asked of me.  This can present a really sticky situation because one can not think of any clinical scenario in which it would be therapeutic to have a therapist tell a patient, ‘Yes, you’re boring, OMG are you boring,’ or ‘No, in fact, I don’t like you.’  And not answering could be viewed as negative response by the patient –if you liked me, you’d tell me, so clearly you don’t like me.  So if the exploration of the question doesn’t take care of the issue, and the patient continues to ask, what’s a shrink to do? Read more »

*This blog post was originally published at Shrink Rap*

Conference Covers Topics About Psychiatry And Law

Regular readers know that every year I tweet and blog from the conference of the American Academy of Psychiatry and Law. This group of forensic psychiatrists consists of about 1800 of the country’s practitioners. Topics are quite diverse and sometimes rather unusual. It’s a lot of fun. Here’s just a small smattering of factoids I picked up last week:

  • The “sovereign citizen” defense can prompt a competency eval, but is not a delusion. The sovereign citizen movement is a recognized subculture of people who believe the government has no jurisdiction over them.
  • Of 200 defendants cleared by DNA, one-fourth had confessed to the crime.
  • According to FBI uniform crime reports, Read more »

*This blog post was originally published at Shrink Rap*

Americans Taking More Antidepressants Than Ever

Remember when the best-selling book Listening to Prozac came out almost 20 years ago?

Now Americans aren’t just reading about Prozac. They are taking it and other antidepressants (Celexa, Effexor, Paxil, Zoloft, to name just a few) in astounding numbers.

According to a report released yesterday by the National Center for Health Statistics (NCHS), the rate of antidepressant use in this country among teens and adults (people ages 12 and older) increased by almost 400% between 1988–1994 and 2005–2008.

The federal government’s health statisticians figure that Read more »

*This blog post was originally published at Harvard Health Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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