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

I tested #ChatGPT therapy skills for several psych problems. Amazed how good it is- great free resource for people who cant afford/access human therapist. But scary wake up call for therapists (& our species). We're recklessly creating our replacements. nature.com/articles/s4159…

I really dont know who does more harm: Psychiatrists/Primary Care MDs who push psych pills for every problem OR Antipsychiatrists who self promote by scaring away patients who really do need meds Meds are absolutely essential for the few/harmful if overprescribed for the many.

1/2 Why current fad fake Adult ADHD diagnosis: 1)Confused w normal distractibilty 2)All psych disorders cause attention symptoms 3)Charlatan thought leaders 4)Careless MDs 5)Patients seek legal speed for performance/recreation/or feed addiction 5)Gains short term/Harms long term

2/2 WARNINGS Adult ADHD diagnosis is dangerous because stimulants make the real diagnosis much worse- eg bipolar/schizophrenia/substance use. Any diagnosis that suddenly becomes common & explains everything is way overused/does much more harm than good/explains almost nothing.

Akiskal urged us to include "hyperthymia" in DSM-IV. Why I blocked it: 1)Hyperthymia better considered normal variant of human temperament- not mental disorder 2)Correlates with success- not dysfunction 3)Rarely a clinical issue BTW: Akiskal was himself a brilliant hyperthymic.

Psych meds way over- prescribed in kids: 1)without clear indication 2)serious short term side effects/long term impact 3)Not enough therapy/family,school,social support 4)Poor/minority kids most harmed 5)Need much better guidelines/monitoring I love practical studies like this:

I'm usually more hopeful about patients than they are about themselves. We seeing them on a worst day/time is great healer. Diagnoses should be cautious & written in pencil: 1)often exaggerate severity 2)cause demoralization re prognosis 3) result in too many meds for too long

I think most change during #psychotherapy occurs because it helps the patient have "corrective emotional experiences"- some happen within the sessions, but most occur via patients stretching themselves in real life.

Prolonged grief: 1)very common after a traumatic loss 2)mostly experienced as expectable, not mental disorder 3)price we pay for deep love 4)responses- acceptance/respectful/relational/ritual 5)psychotherapy needed & useful for some 6)Meds very rarely indicated Great slideshow:

There's no expiration date on grief; no 1 right way to grieve; no cultural ritual that works for everyone; no reason to apologize for missing someone you loved deeply; no "cure". Treatment needed only if grief severe/prevailing/ enduring/disabling enough to = Major Depression.

My def't psychodynamic therapy: Identifying recurring patterns of thoughts, feelings, & behaviors; encouraging insight into how they arose in past relationships & impact present ones; promoting corrective emotional experiences in & out of treatment; helping patients love & work.

I love responses from therapists of other schools saying that below deft of psychodynamic therapy also describes what they do. All good therapy flexible/ integrated/geared to what patient needs. Division into 50 schools silly- best therapists each school look very much alike.

Equally misguided myths: Mental disorders are brain diseases Vs Mental disorders are not brain diseases My chaos theory view: Most mental disorders emerge from complex bio/psycho/social/spiritual interactions- no simple explanations. Best summary brain's role in psychiatry:

Quality of the therapeutic relationship is way more important than specific techniques- why psychotherapy comparisons result in tie scores. This is a pretty good summary; 'Psychotherapy Status Report: Past Achievements/Current Failures/Future Disruptions" psychotherapy.net/article/allen-…

ILLINOIS 1ST STATE TO BAN AI THERAPY! Why so crucial? Chatbots accentuate suicide/psychosis/mania/conspiracy theory. Why only symbolic? People will still use/Trump exec order gives Big Tech a free ride. Needed next? Class action lawsuits/media pressure. share.google/vPAgPnWeE85HJa…

'Saving Normal' has aged much better than I have. Published 12 years ago, it's just as lively & relevant now as it was then. Sorry i can't say the same for my knees or my mind. The word endures better than the flesh.

George Orwell predicted Trump "The whole aim of Newspeak is to narrow the range of thought to make thought-crime impossible because there will be no words in which to express it. Every year fewer & fewer words & the range of consciousness always a little smaller" x.com/washingtonpost…

My views on "Good Grief": Grief is the price we pay for love. We must respect the dignity of pain felt on losing a treasured loved one. Not turn grief into mental disorder. Medicalizing normal grief is an insult to the griever. mobile.nytimes.com/2010/08/15/opi… x.com/DutchessAbroad…