TheLastPsychiatrist—The Last Psychiatrist

TheLastPsychiatrist (User #46425) publishes a refreshing website called The Last Psychiatrist. I like many of the small essays he writes. Psychiatry, at least the many psychiatrists that I work with regularly (at a very well respected teaching hospital which prides itself on its Department of Psychiatry), suffers from both an inferiority complex and an undeserved self-assurance. Many psychiatrists don't seem to take the time to read or understand the literature central to their field; and, much worse, they frequently don't take the time to understand patients, relying on fuzzy and unproven notions about the biology of mental illness. In general, the epistemology of psychiatry is so muddled that psychiatrists don't even seem to have the conceptual tools necessary to seriously think about mental illness and mental health treatment. (There are many reasons for this muddle, and I don't think it's ill-intentioned, but that's a discussion for a different sort of blog.)

TheLastPsychiatrist's website, is quite good, even if I don't agree with everything that he writes. Sometimes his tone is a bit reductive and dismissive, but that seems to be mostly a symptom of his general frustration. His essay from July about Seroquel does a great job of describing why failing to understand a medication's mode of action means that doctors prescribe it incorrectly. His essay on what the Number Needed to Treat is and why it's important is great (here's a similar essay from Slate last year), and I quite like his longer essay on the future of psychiatry "The Massacre of the Unicorns." Although most things on the site are worth reading, his analyses of medication studies and trends in psychiatric diagnosis and prescribing are very strong.

(I saved this in draft as I was writing it, to see an actual patient for actual psychotherapy, and an essay on his site got posted to the front page.)