DSM

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

Psychotic vs. Psychopathic

They aren’t the same. Going back to at least Hitchcock (one of my faves), who brought the muddy term “psycho” into the public psyche, conflated the definitions as if all are violent, and all “crazy” is crazy. I’m sure there are briefer answers out there for those wondering what’s the difference between psychotic and psychopathic. And even though SRSLY made it into the OED because of its widespread use, lay inaccurate uses of the term psychotic will likely not. Briefly in discussing how we got here, the words are interchanged because they sound alike, and are used commonly to describe

Is Walter White a Psychopath?

Walt’s pathological and Machiavellian level of manipulation of others, even those who might describe him as a friend, makes us question who the real Walter White is. Is he a psychopath? Is he a guy who suppressed his basic needs so much during his life that that now he’s just having a narcissistic tirade to prove he’s all-powerful as he approaches death? As a psychiatrist, I view the evidence that points in one direction vs. another. As a writer, I see the brilliance in how we’re led into watching his dark side unfold, while still empathizing with him. Modern psychiatry

Is it Bipolar, or not?

Jesse, a 27-year old guy comes into my office because he had a “rage” attack at his boss. He might lose his job. He’s overweight, not particularly self-conscious with a receding hairline and dressed like he’s still in college. He got upset when his boss criticized his work, so of course he lunged at him and punched. “But that was just my Bipolar.” No, it wasn’t. Because you don’t have Bipolar. Of course I don’t say that. Directly challenging doesn’t often serve the situation or help them to understand what’s happening with them. It would only put them on the

Well maybe it’s like physics. Kinda.

I was at a party once of non-medical people. A woman we’ll call Jill comes up to me. She’s a teacher, 28 years old, and talks to me about her teaching middle schoolers. I mention what I do, and I get a surprised look. She’s intrigued, but then brings up all the complaints she’s heard. “My friend went to a psychiatrist, and they were horrible… And isn’t it true that the DSM is run by drug companies?” “So you’re pushing pills all day?” “Why can’t psychiatry figure it out better?” Where do I start in addressing so many myths? Ultimately

But I’m not crazy, right?

“But I’m not crazy, right?” I get asked this question at least weekly. There’s a person, let’s say twenty years old. Or forty. Or eighty. Or fifteen. Doesn’t really matter the age. And they’ve reached some point where they’re actually starting to question their own sanity, wondering if they’re about to “lose it.” So they come to someone for help. Are they really at risk? Maybe. If so, it’s probably being driven by the fear itself. Of course there’s that old colloquialism that if you think you’re crazy, you’re not crazy. That has a grain of truth. One of the

Yes, Your Doctor Should Be Blogging

And so it begins… A new blog. Another amongst thousands. Is there particular utility or reason to follow this one? I’d like to imagine that this will have usefulness to your life. This is more than just thoughts on psychiatry, but really the thoughts of a psychiatrist who is both enamored with and annoyed by his own field. And with modern culture. So everything. Which raises the question – should a doctor really be blogging? Within medicine there’s a culture of secrecy. We protect our own, not letting on about our problems. Our venues of criticism fall into “peer reviewed

Paul R. Puri, MD

DSM

Resetting the Bar