As a nonpsychiatrist (neurologist) seeing patients with overlying psychosocial problems and some with psychiatric illness, it's difficult for me to understand the positions taken by #criticalpsychiatry. I think in terms of taking care of the patients as they present to me, rather than in some theoretical construct. We don't use such constructs in the practice of medicine and neurology. It seems to me that most of the critical psych people aren't involved in day to day care.

@SashaGusevPosts @VPrasadMDMPH has blocked me (I suppose) for disagreeing with him in the past. It doesn’t surprise me that he himself has a COI problem. I do not consider him to be an “honest broker.” He cites no evidence for his denunciation of the NIH, probably because he doesn’t have any.

Doesn't this ignore the fact that various depressive disorders run in families and appear to have genetic predispositions? No, we haven't yet identified the specific genes in most cases; nor have we identified or isolated the genes for various heritable medical disorders such as diabetes, Alzheimer's, Crohn's, Parkinson's, multiple sclerosis, etc. No one is denying, in this seemingly endless and fruitless debate, that social and emotional causes are responsible for depression and anxiety. But why deny the equally apparent biological factors? The reverse applies to many biological diseases, as well, in which emotional factors contribute to their symptomatology and even their severity and prognosis. The complexity of medicine should not be underestimated.

@psypharmacopeia Beautifully put. That says it all. Same thing applies, to a much lesser degree, in just routine outpatient medical practice. The psych issues are neither philosophical nor are they rhetorical. They are an integral part of patient care.

What if you see something twisted about /not/ medicalizing mental health challenges? What if you see that as detrimental to patient care? As a neurologist, I can’t separate out the mental health challenges from the physical ones. Or if I did, I would be doing my patients a disservice.

@DrAnnieHickox It’s not clear whether what we have here is a coup, or what this writer for Lawfare calls a “state capture.” In any case, it is destructive, destabilizing, and anti democratic. Musk, an unelected technocrat, is at once corrupt and evil.

@dysclinic Small world department: Dr. Phillip Low took care of a number of my patients that I referred to Mayo when I was in private neurology practice. He was great to work with.

@sulmoney I missed the sarcasm. Sorry. There have been a number of posters here who have said just that.

@aussie54 @NormOrnstein We are officially a fascist autocracy now. It was a coup. And it took only two weeks. Imagine what Trump/Musk will be able to do in the next year. We’re doing it faster than Germany did in the 1930s.

This demonization of psychiatry is akin to what the anti-vaxxers do. Both result in many needless deaths. Superstition has always been the enemy of science, and now it has become the enemy of medicine. It should be recognized as such, morally and legally. Mental illness is not a philosophical issue, any more than is heart disease, diabetes, or cancer. The “anti-psychs”, to the extent that they have influence, are doing great damage.

@AllenFrancesMD Agree 100%. Simply he is the most evil politician our country has ever had, and that includes McCarthy and Nixon. (McCarthy did come close— I watched the Army-McCarthy hearings in real time as a kid.)

@DrSuneelDhand Yes, it was time for him to retire.

@sanilrege @psycheureka Fascinating thread. Thanks! Now back to my foraging.

@peterdaou You knew it was a binary choice, and what the result would be. It turned out the way I and everyone else predicted. A total disaster for everyone, including Gaza. Elon Musk was the trick card no one expected.

There is a long profile in the February 10 New Yorker on Alma Mahler, Gustav’s wife. There never will be a profile on Bruckner’s, because he never married, although not for not having tried. According to Google, “Anton Bruckner never married and did not have a wife. He was a lifelong bachelor who proposed marriage to several teenage girls…” Does this explain in some way why Bruckner’s works are so long? That maybe he was never interrupted for dinner? Sorry, there’s no way to post the New Yorker article here. @LeonidasPlatan1

Great introduction to the chapter. As Guze said, “Diagnosis, pathogenesis, etiology, natural history, treatment, and epidemiology are all medical concepts and suggest clinical strategies and research for psychiatric disorders.” The medical model does not imply a purely biological etiology of every mental or emotional disorder. It’s the same way in neurology and in general medicine. Past history and trauma (physical or emotional) play a significant part in medical disorders, as well. Clinicians know this and try to look at the whole person. It’s difficult these days because of lack of resources in both medicine and psychology/psychiatry. The argument for the medical model in psych, seems to me, is its sheer usefulness.