21 Paths

I thought it would be good to return to a more “bread and butter” informational psychiatry post for once. Consider this a drastic reductionism of a complex field. Following the prior post about avoiding benzodiazepines, many have asked — What else can I do to feel less anxious besides take benzodiazepines? The short answer is other (safer) medications, and/or psychotherapy. Like any other blog post, this isn’t a substitution for medical advice, since there can be causes of anxiety that require medical intervention, such as hyperthyroidism. Make sure you get evaluated properly before trying to chalk your anxiety up to

Digesting Hannibal – Season 1 (complete)

As a psychiatrist and a writer, I thought it might be fun to put together a commentary on this great show. I know very little about their development process, including if they have any professional consultants. So this blog series is for play. Consider it a companion piece reflecting my professional thoughts with each of my professional hats (mostly my psychiatrist hat). It’s intended to be read while watching the show. It’s a dense show, so sometimes the analysis can be quite extensive. Sometimes it’s just me waxing as well. Warning: There will be spoilers, so it’s useful to watch while reading. It’s

Perspective on Eating and Overeating

Overeating permeates our society. At the holidays, but really all year long. The strategies that spring up, such as calorie or portion control, weight watchers, focus on an external system. Eating healthier is also important. I’ll admit I have binged on some ice cream now and again as well. Other wisdom about eating tells us that sometimes we’re eating for comfort, for distraction, or mindlessly (while watching TV), or out of boredom. Of course we are. That doesn’t quite tell us the how to eat differently, though. Aside from maybe not while watching TV. I was in the middle of

Fear of Mental Illness

The fear behind mental illness reflects the nature of fear itself: We fear what we don’t know. We can never truly know what is happening inside the mind of another person. We as people follow fixed rules most of the time. Drive through an intersection when the light is green. Wear some amount of clothing outdoors. Don’t cross the double yellow line. So many rules. When rules are broken, it is jarring to us as bystanders. Perhaps that rule breaker is innovative. Perhaps that rule breaker is a genius. Or perhaps that rule breaker is sick. The more bizarre the

Positive Psychology, Lindsay Doran, and Story

Many months ago I attended a lecture by Lindsay Doran on Psychology as an approach to understanding story. It was hosted by the Blacklist. For anyone interested, her Ted Talk covers much of the same material. Ms. Doran is a studio executive that has helped in the development of a number of films, including recently The Lego Movie. She also has a fondness for Positive Psychology. For those not familiar, the wiki page is actually pretty good on the subject. In short, it’s an approach to human psychology that focuses on the positive side of functioning, such as how to

Haystacks: How to Improve EHR and the Healthcare System

I woke up today to a request on LinkedIn from someone at Harvard for a healthcare startup that seemed on its surface anything but innovative. The only interesting thing about it was the word “Harvard.” Another “me too” wellness program. I declined and went on to click on a story in the NY Times about Tim Cook, and how he’s shaping Apple and maybe moving into some more healthcare applications. I flashed back to 5 years ago (2009). I was a resident and could see so many problems with the healthcare system, including the attempts at creating a good Electronic

Your Partnership is a Fantasy

Yes, I’m being dramatic and the title probably borders on clickbait. And yet it’s true. When I refer to partnership, I mean the idea that two people join equally at all times, make decisions equally in all things, and that no one ever dominates. It’s a beautiful utopian idea, post-modern gender roles, where neither “partner” does more than the other. It just doesn’t exist in reality. For the purposes of illustration, I write about roles here in a heterosexual male/female relationship, though this is all easily applicable to same-sex couples. Perhaps there are moments when two people are in absolute

On Loneliness

There’s an emptiness that many of us feel every day. Sometimes we feel it when we’re away from someone. Sometimes we feel it when we’re surrounded by people. It isn’t depression, per se. We have all experienced it. Unless you’re schizoid, of course. Loneliness is a want. When we want, we create a gap between what we have, and what we don’t. That gap hurts. Commonly we try to distract ourselves so we don’t have to pay attention to that pain. We don’t want to feel it. We have this deep fear it will consume us. It is almost as

Resetting the Bar

I’m not a fan of competition. It brings out the worst in people, while trying to bring out the best. So of course I have difficulty understanding athletes using steroids or doping just to win a contest. These drugs have possible health consequences after all. For the athlete, I’m sure they believe it’s about achievement and maximized potential, but it’s driven by trying to be better than the other guy. The bar is set by another person. With that drive they are willing to do “whatever it takes.” Train more. Work harder. We as spectators encourage it and set up

On Balance in Relationships.

This isn’t just about balance. Or how to stay connected. Though it serves all of that. I touched on this just a little bit in my post about burnout, but I want to get into Balance in Relationships. We’re asked to care. We’re asked to do something. We’re asked to invest time and energy. This is usually about a person. Sometimes it could be a project. John was a military vet. He didn’t have to be. He could have been my childhood friend, or a guy I made friends with in a coffee shop. In this case I met him

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Paul R. Puri, MD