I am a resident in psychiatry at an academic medical center. My blog posts describe patient encounters I have had in the course of my training, both past and present. Names and identifying details have been changed. My blog conforms to the information-privacy standards detailed on If you believe you have been a patient of mine and have concerns about the effects of this blog on the privacy of your medical record, please let me know and I will be happy to withdraw any offending material.


JULY 31, 2013 1:38AM

for want of the words

Throughout my medical training, my most enduringly useful skill has had nothing to do with accurate diagnosis, wise treatment, or calming bedside manner.  Instead, it has been a rather pedestrian skill shared by nearly a billion people across the planet: the ability to speak Spanish.

I’mRead full post »

Editor’s Pick
SEPTEMBER 28, 2010 1:52PM

beauty and age

The patient before me is seventy years old.  She wears enormous starlet sunglasses and a sleek pageboy wig.  Her mouth is pursed, plaintive.  As we talk she touches her wig every few minutes and apologizes repeatedly for her appearance, which gives no cause for apology other than thatRead full post »

Editor’s Pick
AUGUST 25, 2010 3:11PM

to be or not to be?

The young woman who sat before me seemed childlike in her baggy sweatshirt, her gaze inscrutable beneath long lashes.  Her story was a common one, though, like all human stories, unique in its details.  In her case: The long-distance relationship.  The unexpected visit.  The empty/… Read full post »

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AUGUST 9, 2010 2:24PM

reefer madness

“Doctor, I’m afraid I might have ruined my brain.” Mr D’s wide brown eyes bore a pleading expression.  He was a young law student with a cherubic dimple set in his left cheek.  He had had no history of psychiatric issues until six months prior to our appointmentRead full post »

JULY 19, 2010 7:30PM

designer brains for all!

So let me say up front that this is a Rant, one inspired by the fifth young go-getter this week to walk across my threshold demanding I diagnose him with AD(H)D and prescribe him Adderall to get him through his dissertation/term paper/research proposal/whatever.


In my (not so) humble opinion, A… Read full post »

JULY 3, 2010 9:03PM

family matters

Mrs U first came to my attention some time after the birth of her first child.  She was a stately woman, dark and slender, dressed always in brightly colored robes.  Her husband brought her to see us because she had stopped speaking.  Ever shy, he reported that she'd become gradually m… Read full post »

Editor’s Pick
MAY 2, 2010 5:50PM

Prozac for the unhappy marriage?

(The characters sketched in this piece are composites of several individuals I’ve  encountered in my training and my life.  They contain elements of real patients and acquaintances but do not represent strictly true accounts of specific people.)

The couple who walked into my office for… Read full post »

APRIL 16, 2010 2:44AM

Aging Brains

(A little note about my extended absence: After a promising start, I let this blog go by the wayside just about a year ago, shortly before I had my first baby.  I find being a parent is absolutely fantastic and also supremely absorbing and time-intensive.  My daughter is now ten months… Read full post »

Editor’s Pick
APRIL 6, 2009 5:33PM

Market competition is not going to fix US health care

Imagine you are getting your car serviced.  You bring it to the shop, you get an estimate.  When the work is done the shop presents you with a bill.  It may be a little more or less than the estimate was, but either way that's what you'll be paying.  Now imagine… Read full post »

Editor’s Pick
MARCH 8, 2009 11:43PM

depression that isn't

What do you do with a healthy patient who wants to die?

Ms K was 95.  Her face was only softly lined, and her ash-white hair was smooth and silky as a girl's.  She was in what one might call quite good health, having survived both a heart attack and a cancer/… Read full post »
Editor’s Pick
JANUARY 25, 2009 1:59AM

Open Letter of Apology to the Patient I Saw Last Night

You came into the hospital hoping to deliver a baby.  In fact you weren't pregnant, but you wouldn't believe that; so the ER called me.  We had a pretty nice conversation.  I didn't challenge your belief that you were pregnant despite a negative urine pregnancy test and an ultrasound… Read full post »

NOVEMBER 28, 2008 11:10AM

OS collage - ponti

Editor’s Pick
NOVEMBER 21, 2008 6:33PM

behold the abyss

The screech of my pager jolted me from sleep. A soft-voiced nurse informed me that they were having some trouble with one of the patients and his behavior was very disruptive to the others, so could I come by and see him, please?

I asked for some further details. Apparently he was… Read full post »

NOVEMBER 19, 2008 11:36PM

kids on drugs redux

Just a reference back to a previous post of mine, with a relevant link from today's New York Times on why we shouldn't be giving drugs to kids without a bit more thought than we're currently giving the issue. Read full post »

Editor’s Pick
NOVEMBER 12, 2008 10:13PM

a science in need of a theory

I've had a number of people wonder why, as someone with a research background, I'd be interested in psychiatry. There's a tendency to view psychiatry as 'fluffy' and not something that would be interesting to a person who has spent years getting down and dirty with cells and proteins.

In my view,/… Read full post »
SEPTEMBER 21, 2008 8:10PM

truth to power

Mr. B. behaved like nothing so much as a cornered animal in the locked psychiatric unit.  Behind closed doors, he admitted his demons to his worried mother, who relayed them to us; but to the doctors he was close-lipped and angry, hiding with insults his fear at what had happened toRead full post »
Editor’s Pick
SEPTEMBER 19, 2008 4:56PM

better discipline through chemistry

Disclaimer: I am not a child psychiatrist and do not speak with professional authority on this subject. These are my own ideas based on various readings and personal experiences.

Everyone loves to hear about someone overcoming obstacles to become a star. This NYT article about Michael Phelps, ADH/… Read full post »
Editor’s Pick
SEPTEMBER 19, 2008 4:02PM

color by number

A new patient walked into my psychopharmacology clinic recently. She seemed not unusual at first. A line in the chart noted that she was somewhat wary of psychotropic medications, but then many patients are, and I don't mind that attitude since I also subscribe to the less-is-more theory of psychiatrRead full post »

SEPTEMBER 12, 2008 4:49PM

mind control II: yours

I wrote yesterday about how surprisingly simple it can be to turn around an angry patient. Two small words hold the key to taming the beast: "You're right." Those words are like a magic tonic, a soothing balm. The patient drops his offensive posture, loses his hostile glare. His hackles soften.Read full post »
SEPTEMBER 11, 2008 10:39AM

mind control I: theirs

I'm in a seminar that meets once a week to educate ourselves in the technique of CBT (cognitive-behavioral therapy). This is one of several available therapeutic modalities (dialectical behavioral therapy, psychodynamic, psychoanalytic, etc etc etc).

We're learning specific, codified techni/… Read full post »
Editor’s Pick
SEPTEMBER 5, 2008 1:56PM

biology vs psychology: false dichotomy?

I was speaking with a very intelligent and insightful patient who mentioned that he'd felt his problems (depression, some obsessional traits, a mild eating disorder) were all 'psychological' until he found a drug that significantly improved them. From that point on he was convinced they were 'biologi
Read full post »
SEPTEMBER 3, 2008 12:53AM

free will and eating disorders

We've a number of eating-disordered patients on the unit at the moment.  Eating disorders have never been a particular interest of mine; but as I work more closely with eating-disordered patients, I've come to realize their problems raise a number of interesting philosophical questions.

We've aRead full post »
Editor’s Pick
SEPTEMBER 1, 2008 11:07AM


One of my more interesting recent cases was that of a young gay man who came to us in despair because he was in love with his heterosexual roommate.

 The two of them were extremely close: eating dinner together, going to movies, and generally engaging in very couple-like domestic activities.… Read full post »

AUGUST 31, 2008 4:37PM

it's all in your head

Psychiatrists - and doctors generally - see two kinds of symptoms.  There are the 'classic' symptoms that have meaning because they signify something we can treat, and the 'off-road' symptoms that don't seem related to any disease process we understand.

In psychiatry, the former are typified by…

Read full post »

Editor’s Pick
AUGUST 29, 2008 12:23PM

demon rum

This vignette is from an outpatient neurology month I did last year, mostly a pretty calm scene compared to the inpatient psychiatric wards - until Ms Q arrived on the scene.  Forty-five minutes late for her appointment, she stumbled in on the arm of the fellow, mascara streaking down her c… Read full post »