Novel Downloads at the Right Price

Dear Readers:

Over the course of the summer, three of my novels have become available on Kindle/Amazon.  Kindle allows for a few days of free promotional downloads, so I wanted to let you know that all the books are available at no cost for just a brief time.

Double Billing is the story of a woman whose life changes when she discovers she has an identical twin she never knew existed. It's a short book and is intended to be a quick read.  It will be available as a free download from Thursday 9/27 through Monday 10/1.

Mitch & Wendy : Lost in Adventure Land is  about two siblings who are struggling with their relationships in the aftermath of their parents' divorce. The story takes place on Wendy's 10th birthday when the kids get lost in an amusement park, only to learn they are being followed by a man who knows all about them from Mitch's misguided Facebook life.  Written for 3-5th graders, or the very young at heart.  It will be available as a free download from Thursday 9/27 through Monday 10/1.

Home Inspection is a story told through psychotherapy sessions in a format that is similar to the HBO series In Treatment. Dr. Julius Strand is a psychiatrist who plods along in his already-lived life until two of his patients inspire him through their own struggles to find love. It will be available as a free download on Thursday September 27th only, and for 99 cents from 9/28-10/1.

If you don't own a Kindle, you can install a free Kindle app on your computer, tablet, or cell phone by going here.
All three books are also available as as paperbacks from Amazon.

Rather than giving different links to all these books and formats, there is a single link to my Amazon page with all the options here.

In non-fiction news, Shrink Rap: Three Psychiatrists Explain Their Work, written with Clink and Roy, will be released as an audio-book very soon.  It remains available in hardcover/softcover/Kindle/Nook, but so far, Hopkins Press has not felt inspired to give it away for free.  The three of us are very pleased with the enthusiastic reviews it has gotten.

I'm more than happy to have people download my novels at no cost -- I'll be keeping the doctor day gig -- so please tell/tweet/blog/share the free promotions to anyone you think might be interested.

Finally, If you do read any of the books, please consider putting a review on Amazon.  
Thank you so much,
 Dinah
The Accessible Psychiatry Project

Double Billing is Now Available as a Paperback

Here is the link. 

Mitch & Wendy: Lost in Adventure Land

My last novel (at least for now and probably forever) is now available as a Kindle book for 99 cents.
Mitch & Wendy: Lost in Adventure Land.  It's a kids' book, meant for the 10 year old set.  No psychiatry.  There is a bad guy and a two scary chase scenes (the chapters are labeled "This is the scary part") so if you have a youngster who is prone to nightmares, perhaps you should read it first, and it's not for very young children.

After all three of my books become available as paperbacks, I will offer free promotions of the Kindle books. 

Product Description

It's Wendy's tenth birthday -- double digits at last -- and she goes to an amusement park with her mother and her brother, Mitch. The day, however, gets off to a bad start. Her best friend has a fever and can't come. The day only gets worse when Mitch and Wendy get lost in the park, only to meet up with a strange man who seems to know all about them.

Two siblings struggling with major changes in their family find themselves in a scary situation.

Written for 4th to 6th graders, Mitch and Wendy are trying to renegotiate their relationships with their parents and with each other following their parents' divorce and remarriage. Mitch escapes to Facebook and a sports friend he meets there who seems to really understand, only to face disastrous consequences.

Review of Crazy

No no, we're not reviewing what it means to be "crazy."  


I recently finished reading Pete Earley's book,  Crazy: A Father's Search Through America's Mental Health Madness.  Fives stars, two thumbs up, all the way.  It was a quick and engrossing read, I think I got through the whole book in three sittings. 


Mr. Earley starts with the story of his son, a young man just finishing college, who becomes delusional and disorganized.  Efforts to clarify a diagnosis and get him treatment are a bit difficult, in part because he doesn't really want help, and perhaps because these efforts span two states as the son is in school in New York but the father lives in Virginia.  Earley goes to NY to fetch his son, and alarmed that he is so delusional, disorganized, and talking about death, he takes him to an Emergency Room in Fairfax, Virginia where he is told that the son can't be committed against his will unless he has already had a suicide attempt.  The son goes home, does some strange things, then breaks into a random house where he shatters pictures, leaves water faucets running, and takes a bubble bath.  He's no longer in the voluntary psychiatric system, per se, but is now charged with felonies that will prevent him from ever being licensed in his chosen profession.  A plea bargain is reached-- for misdemeanors/probation/treatment--  but in court, the prosecutor can't cut the deal because the homeowner-victim won't allow the crime to be pled out without a felony charge.  Does the victim really get to call the shots on what a criminal is charged with?  

Earley is understandably frustrated with the system and all the roadblocks in everyone's way.  He's worried about his son's future, and a bit terrified that his son will get sick again.  Mike can't catch a break, and his diagnosis and criminal record seem to call his life to a halt for a while.  The son does well on Abilify and Earley could be their spokesman.

 The author decides to explore the system by spending a year following patients in the Dade County (Miami) jails and talks about a psychiatrist he shadows who sees his patients for an average of 12.7 seconds.  Earley describes a whole jail unit full of really sick people who are combative, catatonic, and treatment-resistant, in a way I've never seen in nearly two decades of work in community mental health clinics.  Never....well.... Clink says this is all in a day's work for her, but it's not routine stuff for outpatient psychiatry.   The psychiatric unit he describes in the jail is disgraceful, with cold, naked prisoners lying on the floor next to the toilet, in need of blankets and kindness.  It felt like a human zoo, only in animal zoos, the creatures are treated better, I hope.   The tales Earley tells are sad ones, the people he follows end up still sick, imprisoned, or dead, and the system he describes simply doesn't work.  And the patients, some of them are so sick that there is simply no place on earth for them, and Earley faults the state mental hospitals for releasing them.  Even a well-monitored forensic patient ends up doing well, getting a job and living with his girlfriend, only to kill her.   It's all just horrible.  Real life outpatient psychiatry isn't so bleak, and while there are some awful and sad stories, there are many people who do fine.  I felt badly for Mr. Earley because he chose the most dismal of places to search for answers, and I think (or at least I hope) it's unlikely his son will end up in such devastation.  Along the way, he talks with other parents and becomes involved with NAMI.

The author does a good job of getting inside the mental health system.  I didn't agree with him on his easy separation of substance abuse and mental illness, and I don't think we know that drugs don't cause mental illness; they certainly exacerbate it, induce symptoms that mimic it, and make diagnosis and treatment nearly impossible in some settings. 

Mr. Earley is a proponent of involuntary treatment.  He talks to people while they are living on the street, eating from trash bins, victimized by rapists and robbers, and he doesn't buy that people should have the right to live this way.  Earley twice quotes Wisconsin psychiatrist Darold Treffert as saying they get to "die with their rights on."   He wants state hospitals back and he wants them to treat patients humanely.  

If you oppose involuntary treatment under any circumstances, read this book: it will either change your mind or raise your blood pressure.  

Oh, and if you'd like, try Mr. Earley's website and blog at http://www.peteearley.com/blog/

Trading Stacks for Page Views

Whoa, I think this news marked a turning point for medical educators:

Here's an article on ZDNet.com about the Johns Hopkins medical library shutting down for good. No more bricks-and-mortar, wandering the stacks, paging through paper medical research. I spent a fair amount of time in real, physical medical libraries during my training. I have to say, being able to log in from the comfort of the living room couch and download any PDF I need is the way to go. Nevertheless, I couldn't help but feel a twinge of nostalgia.




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And now for something completely different. I thought you might enjoy our new animated mascot!

Podcast #60: On the Verge

Please take our sidebar poll and tell us who you are.
  If you don't know who you are, please guess.  

In Podcast Number 60, we discuss the following:

Questions from readers--

• Sarebear asks: What is a Nervous Breakdown?
• Mary and Max, an award-winning claymation movie about an 8-yo girl and a middle-aged man with Asperger's. Very educational about Asperger's, and extremely entertaining.
• Another reader asks: How are psychiatrists prepared to manage psychiatric disorders in patients with autism?

• The New York Time review of a movie, Beautiful Boy, which led us in to a discussion of guilt and blame and our desire as human beings to believe we have control over what happens to us.  Too bad none of us saw the movie.

• Clink talks about an article that appeared in the Archives of General Psychiatry, National Study of Suicide in All People with a Criminal Justice History.

• Finally, we talk (or perhaps "ramble" is a better word) about the psychology of podcasting.

Thank you for joining us!

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This podcast is available on iTunes or as an RSS feed or Feedburner feed. You can also listen to or download the mp3 or the MPEG-4 file from mythreeshrinks.com. 

Thank you for listening.

Send your questions and comments to: mythreeshrinksATgmailDOTcom, or comment on this post

To review our podcast, please go to iTunes.
To review our book, please go to Amazon.

Thursday Apr 14 7pmET: Shrink Rappers to be LIVE on BlogTalkRadio

You all remember Doctor Anonymous, right?  He's the family medicine doc medical blogger who we've known since Al Gore invented the internet.  Well, he's not so Anonymous anymore, writing a blog called Family Medicine Rocks under his other name, Mike Sevilla, MD.

Mike is interviewing us about our upcoming book (expected to hit the shelves now at the end of May) on BlogTalkRadio. Mike interviewed us before, which we put out as a podcast (#36a), I think.  He'll be asking us questions about the book and the process, which will help us prepare for our Talk of the Nation interview on NPR on May 3.  And we'll be asking him what he's been up to.  I want to find out his experience treating psychiatric illness as a family medicine doc, referring to mental health providers, and such.

So, tune in Thursday (tomorrow) at 7pm Eastern. You'll be able to call in and join us in the conversation.  The link is HERE.  (Note that it says 11pm, but I'm sure we agreed to 7 so he'll probably fix it soon.)

My Friend, My Shrink

I just finished reading Dr. Gary Small's book, The Naked Lady Who Stood on Her Head. I talked about it during our podcast, and maybe, someday, that podcast will be posted.*

In the final chapter of the book, Dr. Small talks about his mentor, friend, and father-figure who has been mentioned throughout the book. The mentor approaches him on the golf course, where they meet to talk, and says he needs psychotherapy and Gary is the man to do it. The author is surprised, hesitant, and a bit uncomfortable with the demand (it comes as more than a request). His wife likens it to the need for a plumber or a dentist, and Dr. Small takes on the task. The mentor calls all the shots: where the meetings will be, what pastry they will eat, the form of his payment. The author initially misses the diagnosis and uses this as an example of how one can be blinded.

So is it okay for a friend to treat a friend?

I was in an institution where the resounding feeling is that psychiatric disorders are medical diseases like any other: the patient should go where the care is best. Obviously, our institution gave the best care, and so there was no taboo about faculty being treated (or even hospitalized) within the department. This is not to say that everyone treated their friends, but people might not move their care as far away as one might imagine (and sometimes people treated their friends).

At the same time, the standard professional boundaries suggest that friends should not treat friends, and that such arrangements are not kosher, especially after the fact if the treatment is called in to question.

Dr. Small talks about a delay in diagnosis. He doesn't talk about the fact that the patient here is dictating the care in a way we generally don't view as being helpfu to patients-- even VIP patients-- or that the desire to please authority figures can be very powerful.
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* Regarding the My Three Shrinks podcast: We've decided that I, the non-geek, should try to produce the podcasts for the near future. Roy said he'd rather stick a fork in his eye than teach me to do this. Clink is trying, but even the process of transferring the recordings to my computer has been rough, not to mention that our podcast programs don't sync. Soon... we hope.

Our Readers' List of Best Shrinky Books

I asked for Shrinky Book recommendations, and I thought I'd compile the full list of recommendations. Thank you for your help, and here goes:

Aqua said...

Existential Psychotherapy , by Irvin Yalom. This book resonated so deeply with me. It has helped me get so much more out of therapy than I ever imagined possible.

Rach said...

Totally agree with Aqua. I'll add Kay Redfield Jamison's books books. And for the totally obvious one, the DSM-IV-TR . (I know it sounds counter-intuitive, but for some people, reading about what they "have" provides some semblance of relief. or comedy. or tragedy. or a combination.)

Mindful said...

My recommendations: Shoot the Damn Dog: A Memoir of Depression by Sally Brampton; Darkness Visible: A Memoir of Madness by William Styron; An Unquiet Mind by Kay Redfield Jamieson; and Man's Search for Meaning by Viktor Frankl.

Sarebear said...

Don't you hate it when it's on the tip of your tongue/fingers/brain but you can't quite come up with it? Flowers for Algernon has always been a fave, if that fits. Sad though. Kay's an Unquiet Mind never did much for me; alot of it was, well, her friends were all in the field, so she had a helluva support system. Nothing like the real world for most people. Not that that makes the book invalid for any "list"; just is why I don't like it. "In Session" by Deborah A. Lott The Dance of Anger by Harriet Lerner The Dance of Intimacy, Harriet Goldhor Lerner, Ph.D. The Search For the Real Self, James F. Masterson, M.D.

Anonymous said...

Second "In Session" by Deborah A. Lott. Also liked Harriet Goldhor Lerner's "The Dance of Intimacy". Yalom and Kramer's books are good. "The Anxiety & Phobia Workbook" by Edmund Bourne, Ph.D and "Self-Esteem" by Matthew McKay, Ph.D are useful resources for cognitive work. Liked Syd Baumel's "Dealing With Depression Naturally" for complementary and alternative therapies. And also liked "The Seven Principles for Making Marriage Work" by John Gottman, Ph.D and "Hold Me Tight" by Sue Johnson, Ph.D for couples/relationship issues.

Anonymous said...

Womens' Moods:What Every Women Must Know About Hormones, the Brain and Emotional Health - by Deborah Sichel and Jeanne Watson Driscoll. Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder - by Jim Phelps

Anonymous said...

The Sociopath Next Door - made such a difference in my life in both recognizing such people and realizing that I was not the problem.

Rach said...

I third In Session.

"In a House of Dreams and Glass" By Robert Klitzman, MD About his Psychiatric Residency-excellent! (He later wrote a book, i believe it's called "When Doctors-or Physicans-Become Patients", based on his own severe reactive depression when his sister was killed in the Twin Towers...) The classic, wonderful "Mount Misery", sequel to "House of God". "The Gift of Therapy" Irving Yalom, MD

Anonymous said...

Marya Hornbacher wrote two books that describe her mental illnesses that are a very good first hand account of what it might be like to have them. Wasted (written in her early 20s) describes her childhood and teen years struggling with bulimia and anorexia. Madness (written in her later 20s or early 30s) describes her manic and depressive breakdowns which she had later, after writing wasted. When she wrote wasted she did not know she had bipolar disorder.

merope3 said...

Best book about depression I ever read? "Crime and Punishment." I've never had a fictional character resonate so powerfully with me before.

Ally said...

Deborah Luepnitz's book on intimacy. Dan Gottlieb. And absolutely Jim Phelps and Kay Redfield Jamison!

Paula said...

hmmm, shrinky books ... um, probably "Gas Smells Awful" by Helen Razer, covers some important issues in a non-conventional kind of humorous way.

Anonymous said...

I wrote a long comment and my connection crashed! I am reading "MAD, BAD and SAD: A history of women and the mind doctors from 1800 to the present" by Lisa Appignanesi I would recommend this book to people who want a more longitudinal view of psychiatric medicine. It's not one for the here and now "what is therapy, how does it work". For anyone with an interest in the history of medicine and the background and major players in the field of psych, this book might be for you. Along the way there are vignettes, some familiar and others more obscure. I am reading it slowly, it's not a 'page turner'. All I can say is that I am glad I am alive in the era of prozac and bupropion. Paperdoll

tracy said...

Definately agree on Mayra Hornbacher!!! She's excellent! Also, "Gracefully Insane" the history of McLean Hospital. Some really sad and touching stories there...to put it mildly.

dr. bob said...

Users of my web site have voted to highlight: In Session: The Bond Between Women and Their Therapists by Deborah A. Lott and Marie Cohen Feeling Good: The New Mood Therapy by David D. Burns The Road Less Traveled : A New Psychology of Love, Traditional Values and Spiritual Growth by M. Scott Peck http://www.dr-bob.org/babble/psycho

 

Kathy said...

Hi there - here are some books most of you won't have heard of... I had a black dog - Matthew Johnstone, 2005. A brilliant, illustrated insight into life with the black dog and how we might tame it. Living with a black dog - Matthew and Ainsley Johnstone, 2008. A must-have guide for the partners, family, friends and colleagues of people suffering depression. Broken Open - Craig Hamilton, 2004. A memoir of what it's like to go mad in public and survive to tell the tale. My brush with depression - The Greg Wilson Story - Aaron Cootes and Greg Wilson, 2005. A biographical story which shows how much others' support can help one overcome depression. Journeys with the black dog - Inspirational stories of bringing depression to heel, 2007. Edited by Tessa Wigney, Kerrie Eyers and Gordon Parker. Dying for a cure - Rebekah Beddoe, 2007. A memoir of antidepressants, misdiagnosis and marketing disguised as science. I suffer chronic major depression. These books have touched me in various ways and helped me in my journey. Sometimes hearing someone else describing circumstances similar to my own has been the only thing that helped me to keep part of myself grounded in reality. I think it is always helpful to know that you are not alone in what you are experiencing.

 

Anonymous said...

Oh and I forgot to mention, with my network crash and all.... I so love "Staying Alive: Unreal Poems for unreal times" Edited by Neil Astley 500 life-afirming poems, fired by belief in the human spirit. They connect our aspirations to humanity and have help me in deep dark moments. Was I a book reviewer in a former life? Any one who feels low, please read these poems. I hope they help comfort you in the grey dark moments and give you that comfy, all is well feeling with rain falling on a tin roof. Excerpt p 456 Late fragment: And did you get what you wanted from this life, even so? I did. And what did you want? To call myself beloved, to feel myself beloved on this earth Raymond Carver Paperdoll

 

Attachment Girl said...

I would highly recommend "A General Theory of Love" by Thomas Lewis, Fari Amini, and Richard Lannon. It discusses, very poetically actually, the relationship between attachment theory, neurobiology and how we actually heal in therapy. The insight it gave me into the process was a major turning point for me. Highly accessible for layman, but my therapist also loved it.

 

butterfly said...

Being Ourself, by therapist Ty Clement has been the most valuable book I've encountered in my existential journey to healing.

 

Katie said...

Every single one of Kay Redfield Jamison's books - including her textbook on Manic Depressive Illness: Bipolar Disorders and Recurrent Depression. Also, Narcissism and the Psychotherapist, by Sheila Rouslin Welt, William G. Herron Learning from the Patient by Casement was Very Psychoanalytic based, but interesting Hurry Down Sunshine (Michael Greenberg) was a beautiful book about mental illness, not shrinky, though I very strongly dislike most of Yalom's writings...I know they are quite popular but I find them to be lacking any substance, and his writing to be quite full of himself.

 

Dr X said...

Regarding Katie's comment on Yalom, I feel the same way. I don't understand Yalom's popularity. His work strikes me as shallow. I also agree with the endorsement of Casement's book. It's an excellent presentation of self-supervision, supervision by the patient and the unconscious, interactional dimensions of treatment.

 

Sherri said...

Undercurrents, by Martha Manning

nardilfan said...

I'd love to be able to sound all pretentious and say Madness and Civilization by Michel Foucault - but unfortunately, I've actually read it and it seems to be nothing more than a long, boring, over-complicated, deliberately unclear and factually incorrect exercise in making Michel Foucault look cleverer than he actually was. Reading that drivel made me appreciate the humour of the Postmodernism Generator (at http://www.elsewhere.org/pomo/ ) - and of Alan Sokal's infamous parody paper, Transgressing the Boundaries: Towards a Transformative Hermeneutics of Quantum Gravity ( see http://www.physics.nyu.edu/faculty/sokal/transgress_v2/transgress_v2_singlefile.html ). There are quite a few fiction books which I think are worth mentioning, if they can be made relevant. One Flew Over the Cuckoo's Nest, for example, although it is fiction and set a fair distance in the past, still has a lot of relevance in terms of issues around compulsory treatment, the differences between a prison sentence and psychiatric incarceration, and lots of other fun stuff (and does it a lot more effectively and entertainingly than Foucault's effort). For instructional manuals, there's the hilarious (and irritating) "Mind Over Mood" - which is used in the NHS, seemingly as a way of relieving the staff who actually deliver CBT of much of their workload. It's supposed to be used in conjunction with the clinician's version, and you work through it together. Can I suggest that as well as a bibliography you include a list of helpful and/or interesting MH-related films? There are a LOT of very interesting films that deal with many different aspects of mental illness, treatments, social attitudes etc. .\

 

Anonymous said...

Irvin Yalom, Nassir Ghaemi & Paul McHugh are all psychiatrists whose writings I admire. I also enjoy reading books that offer a more critical view of therapy/ psychiatry/ psychology/ etc, because these books have really made me think and re-think some of my beliefs about therapy/ diagnosis/ etc. (I say this as a patient): -Manufacturing Depression by Gary Greenberg (I just read it, one of the best books I've read) -Therapy Culture by Frank Furedi (and I would love to be able to read through the entire bibliography for this book...) -Bright-Sided by Barbara Ehrenreich (esp because of her chapters on the positive psychology movement) -The Loss of Sadness by Alan Horwitz and Jerome Wakefield -From Morality to Mental Health by Mike Martin -The Antidepressant Era by David Healy

 

Anonymous said...

The 10 best ever anxiety management techniques by Margaret Wehrenberg What works, why it works, what to do when it doesn't work The gift of therapy by Irving Yalom Even though he is self promoting, he's still right Our Inner Conflicts by Karen Horney Understanding and making peace with resistence All together 3 different approaches that make sense

Alison Cummins said...

Don't know what a "shrink book" is, but this is one that was helpful to me" http://www.noondaydemon.com/

Sunny CA said...

My favorite shrink book is: "Should You Leave?" By Peter D. Kramer

Sunny CA said...

"The Man Who Mistook His Wife For A Hat" by Oliver Sacks is another favorite shrink book.

d'Zhuoy said...

Noonday Demon -- yes, yes, yes! What an incredible book. Even better than William Styron's Darkness Visible (which you might consider). Then there's A. Alvarez's books Night (1996) and The Savage God: A Study of Suicide (date?). I'm sure you've already added these three by Kay Redfield Jamison: Night Falls Fast, Touched with Fire, and An Unquiet Mind. Emile Durkheim's classic On Suicide. In a more literary vein there's Ted Hughes's The Birthday Letters, poems on the suicide of his wife, Sylvia Plath. Fascinating look into the mind of one who was left behind. The Plath-Hughes marriage is a rich vein for primary and secondary texts, from Plath's correspondence to feminist psychiatric critiques. I would encourage you to include some books that offer critiques of psychiatry. I'm not talking about the silly antipsychiatry spoutings of Scientology and the like; I'm talking about reasonable, rational critics like Thomas Szasz. But maybe I'm way off base.

d'Zhuoy said...

Oh, and also... your ducky reminded me of my favorite-ever episode of The Ze Frank Show: http://www.zefrank.com/theshow/archives/2006/05/050806.html The best use of 3 minutes I can think of.

From Dinah: Thank you, everyone, for you help!

What's Your Favorite Shrinky Book?

We're going to start working on The Suggested Reading section for our book. We know what our favorite books are, but if you've read something that's been helpful, we might want to include that. Needs to be mental health related, doesn't need to be either by or for psychiatrists. We welcome your suggestions! And thanks to Alison who gave us The Noonday Demon.

Unhinged-- The Trouble With Psychiatry by Daniel Carlat, my Review

Unhinged. The Trouble with Psychiatry--A Doctor's Revelations about a Profession in Crisis by Daniel Carlat.


Disclaimer: I wrote this book review while I was working on the final draft of our own book, so it's hard not to compare our book and style to those of Dr. Carlat. Ours is better (just so you know). This is not the result of a controlled study and there was no pharmaceutical agency support. It's simply my biased opinion.

So, I started out poised to hate this book. Dr. Carlat is a shrink/writer who has both a blog and an e-newsletter. He has a good reputation in the medical blogosphere, at least I think that's the case. So why was I poised to hate the book? I was offered a review copy by the publisher -- an inquiry email came with hype: "Carlat exposes deeply disturbing problems plaguing his profession." “The shocking truth is that psychiatry has yet to develop a convincing explanation for the pathophysiology of any illness at all.” "This has to stop—and it can. Throughout the book, Dr. Carlat provides empowering advice for prospective patients, describing the kinds of treatments that work, and those that should be avoided. In the final chapter, he provides a powerful prescription for how to get psychiatry back on track."

Yup, it's true, we don't know the actual pathophysiology of most of the psychiatric disorders. Is this shocking? Deeply disturbing? We've got a long way to go and we've got issues in our field. . Does it help to use language that sensationalizes these problems? It's kind of shocking that we haven't cured cancer, dementia, or obesity . I started reading. Carlat presents the fact that we don't know the actual causes of psychiatric disorders as though it's some big secret, something we purposefully withhold from our patients. He doesn't say that exactly, but he implies it with statements about how doctors don't like to admit what they don't know.

Okay, so the book is full of Carlat's epiphanies and revelations: he starts with the realization that it is limiting to see patients for a 50 minute evaluation, write a prescription, and then have the patient come back in a month for a 15-minute visit and refer them to a social worker or psychologist for therapy. Maybe this isn't the type of practice Dr. Carlat was meant to have! It's the way some psychiatrists practice, but it is not the way all psychiatrists practice. He writes as though this is the standard in the field and what we're "taught" to do. It's what some docs do and are comfortable with, but we aren't told that this is how you must practice, and no one packages this version of care as the best, highest standard of treatment. I personally don't like that he peddles the notion that a large volume/brief contact practice is the only thing psychiatrists do.

Later in the book, he talks about the use of therapy by psychiatrists, and discusses one psychiatrist who sees patients for psychotherapy -- she lives in a rural area and she makes half the income of the average US psychiatrist. She is the only psychiatrist he talks about who sees patients for psychotherapy--the others are a now-retired, lost generation of older docs who had it right. I know psychiatrists with psychotherapy practices who make reasonable livings. He doesn't even touch on this possibility, and in a single sentence he dismisses the idea of a fee-for-service, non-insurance based practice. It's not reasonable to present the field in the light that all psychiatrists do is write prescriptions....quickly and badly at that...and that there's no time for thoughtfulness. It got me thinking that -- at least among Shrink Rap readers -- and our informal, non-scientific polling reveals that 44% of readers who responded see their shrink for 45-60 minutes per session (the most frequent answer by far) and that less than 20% of readers see their psychiatrists for 15 minutes or less. Granted, we may have a skewed readership of those who are thinking a lot about their care and perhaps more apt to seek out something more fulfilling. A quarter of our readers see their psychiatrist weekly (also the most common answer but not by much), about the same number who see their psychiatrists every three months. At least among Shrink Rap readers, we can conclude that psychiatrists practice in a variety of ways and it's not uncommon for people to see psychiatrists for 50 minute sessions, or to see them weekly. I'm sure this varies depending on the region of the country, the availability of psychiatrists, the financial needs of those psychiatrists, the setting in which treatment takes place, and the role insurance has in determining care, and the age of the practice-- with the idea that patients may start out with weekly treatment and move to every one-to-three months after they get better. But Carlat glances over those issues. Dr. Carlat notes that fewer docs offer all their patients psychotherapy. One of the figures he quotes is that only 11% of psychiatrists offer psychotherapy to all patients at every visit. Hmm... All patients. Every visit. Some of this might depend on how we each define psychotherapy -- and there is no standard to that -- but if I was asked this same question, I'd say No. I work a half day a week in a clinic and there I see patients who also see a social worker/therapist. I see two patients an hour there, and sometimes they talk and I listen and sometimes it feels a lot like psychotherapy, and sometimes it doesn't feel anything like psychotherapy, but I would say that No, the therapy is done by the social workers and I don't "offer" psychotherapy to "every patient" I see in every capacity of my practice of psychiatry. And I would ask, "how exactly are you defining psychotherapy?" Read the Shrink Rap book (Spring, 2011) and we'll talk more about this. Interestingly, by the end of the book, Carlat talks about doing psychotherapy in 20 minute sessions.

Okay, so he says psychiatrists are taught to write prescriptions and aren't taught how to do therapy. Only he talks in some detail about his therapy supervisors, their thoughtful insights, how he was supervised in a psychodynamic style, and later he talks about how his training program educated residents in Cognitive Behavioral Therapy. Are we taught therapy or not? This all sounds quite reasonable-- what's he complaining about? For the record, I think I finished training at the same time Carlat started (so, 3 years earlier than he) at an institution with a strong biological focus, so I don't think our differences in opinion on how docs practice is about orientation or timing .At the end of the book, Carlat proposes some solutions: Psychiatrists should NOT go to medical school, it's a waste, and they should have more stream-lined training. All psychologists should be taught to prescribe medications. He had no problems with the DOD program in Louisiana, where 7 years of the program taught a total of 10 psychologists to prescribe. He says this type of program is safe and works well. He fails to note that it cost the military over $600,000 per psychologist (why? no idea?) and that's why they stopped it. Or that it did not decrease the mental health treatment shortage in Louisiana. I'll spare you my rants, you can read about psychologist prescribing here, in a piece by Ron Pies and the article does reference Dr. Carlat. He talks about his own revelations that Cognitive Behavioral Therapy works well, that it's good to ask a patient with a recurrence of depression if anything is going on in their lives (funny how that works), and how he he now does a brand of therapy that he calls "therapy lite." I found the examples to be a bit condescending -- his description of therapy sounds a bit like common sense.

Carlat's book may make him enemies. I'm wondering who his audience is:

-- it might appeal to the anti-psychiatry audience, at least from the cover hype, only much of the book is a fairly reasonable discussion of our work, and so it's not really anti-psychiatry.

-- I don't think many psychiatrists will agree that medical school should be done away with for us, or that other professionals can do what we do as well and as safely.

-- The alarmist tone just didn't go over well with me.

-- Sometimes it felt like he quoted studies when they fit his agenda. There were several mentions of how psychiatrists feel inferior to other doctors, and I'm not sure what to make of that one. Is this a universal phenomena?

-- His bash on how pharmaceutical companies interface with psychiatry include some of our major psychiatrist players here. But if you want to hate the drug companies, this is the book to read.

So what was good about it, why did I read it to the end, and why would I ever put this review on Shrink Rap? After the beginning, Carlat presents a reasonable view of how the DSM is crafted, including the controversies about disclosure in the process of writing the new DSM-V. The most interesting part of the book, however, is his discussion of how the drug companies have influenced research, publications, and practice. Some of this I had read in the New York Times. Some was news to me. I've never seen this side of the pharmaceutical hard-sell -- it was interesting, a bit shocking, and definitely eye-opening. His insider's view of this world is revealing.

So is Daniel Carlat the emissary of truth and ethics while the rest of us remain busy trying to get the big bucks by seeing too many patients too quickly or by getting money unjustly from the pharmaceutical industry? Read the book and see what you think.

Twitter Novel About a Psychiatrist and a Drug Company

So this is something different. A novel... by a psychiatrist... released 140 characters at a time via Twitter (@goosenovel). If you try to read it via Twitter, you have to start at the beginning, so it is easier to catch up by going to his novel site, for the twitter-impaired. It is written by Doug Bremner MD at Emory, who has already written a book about drug safety.

I thought the idea of a twitter novel was interesting (and surely Dinah will have something to say about this).

What's Holden Got?

There's a copy of the DSM-IV sitting on my coffee table. Not the usual, not even at a Shrink Rapper's house, but I'm trying to write the Shrink Rap book and, in theory, I may need to look something up.

So, kid looks at the DSM and informs me, "We read that in English class today." They read the DSM in English class? Hey in the good old days, we read Macbeth in English class. We didn't need psychiatric diagnostic manuals. "Oh, why?" So they're reading Catcher in the Rye and they decided to diagnose Holden Caufield. Interesting. What's he got? Oh, we shrinks don't do that. Until I personally examine Holden, I'm not venturing a guess as to his psychiatric diagnosis. The APA and the medblogging community would have me de-shrunked.

So what did the English class say? (They're kids, they can venture guesses if they like). One thought he had Borderline Personality Disorder, some thought he had Bipolar Disorder, and a few thought he had Schizophrenia.

Funny, I was writing today about how hard it is to diffentiate developmental issues, family complexities, and psychiatric illness in adolescence. Seems like a funny coincidence.
Well, what's Holden got?

Book Pics!

Wow! Thank you all for the great novel suggestions.
First, I'm going to tell you some of my favorites, then I'm going to print your comments below.
In no particular order:

The Kite Runner ---maybe my All Time Favorite book?
Lying on the Couch -- by a shrink about a shrink, quick read
I Know This Much Is True-- starts with a man in a library cutting off his own arm, lots of psychiatric issues.
Middlesex -- a novel about gender identity in a young woman who begins masculinizing at puberty...great read
Of Human Bondage-- a classic about obsessive love
The Poisonwood Bible
Blink
Outliers-- Both by Malcomn Gladwell. Neither are novels, both are great reads.
The Orchid Thief also not a novel, but I was 25 pages into it before I realized I wasn't reading fiction.
The Namesake.... and then you have to read The Overcoat
Snowflower and The Secret Fan
Waiting
Atonement
A Gesture Life-- I loved this
Native Speaker
Life of Pi
The White Tiger
Out Stealing Horses
God of Small Things

Three Cups of Tea--somehow I never got into it. And as a kid, I loved Kurt Vonnegut so it was fun to see him on the list in our comments below. And my pic for the moment was Shadow in the Wind.

Reader Recommendations:


Have you read I Love You, Beth Cooper by Larry Doyle? Doyle used to write for the Simpsons tv show and Beth Cooper is a funny book along those lines--intelligent but lighthearted. Perfect for anyone who needs some un-brooding. Grab the paperback edition for extra laughs. The back pages are filled with true high school horror stories. I wish you good reading.

Just start Alexander McCall Smith's hilarious "The No. 1 Ladies' Detective Agency" series, whose protagonist Precious is an amateur detective in Botswana who snoops and fixes her neighbors' business. You will laugh out loud, but her comments on character and motivation are pretty universal in application. Wonderful characters. One in the series describes a woman searching for her supposedly straying husband who, it turns out, has been eaten by a crocodile while being baptized in the river by an evangelical sect. Smith grew up in Africa. It's light reading but good.

Other possibilities:

Cold Comfort Farm by Stella Gibbons ("I saw something nasty in the wood shed..." is the most famous line)
I Capture the Castle by Dodie Smith
(cool eccentric and tragic British family in the 1930s)

For a real brooding downer (but good) there's always Malcolm Lowry's "Under the Volcano" ("the world was always within the binoculars of the police")
Current favorites: Shusako Endo and Nobel Laureate Jose Saramago.

I agree with Anon 2's recommendation of "Snow Flower & the Secret Fan", Catherine's "Time Traveler's Wife" and Dragonfly's "The Book Thief".

I just started "A Thousand Splended Suns" by the author of "The Kite Runner".

Outlander series by Diana Gabaldon. Right now there are 6 volumes. You will be sucked in. =)

I'm also in the middle of Middlesex (mentioned above) and it is a good read, too. :)

Pure escapism?
Try anything by Neil Gaiman. I loved Neverwhere and American Gods, and couldn't read them fast enough. His other books are great, too. :)

Pure fluff? I'd try any of the Speedy Motors series (the first of which is The No. 1 Ladies Detective Agency) by Alexander McCall Smith.

Anything by David Sederis (his books must be fiction)

Anything by Sue Hubble - essays about science - but Waiting for Aphroditie is my favorite

Curious Incident (although I firmly believe that A Spot of Bother, his newer one, is far better)

Never Let Me Go - I absolutely loved this

Oryx and Crake - fantastic too, but preferred The Handmaid's Tale

Pharmakon - maybe a little close to home (psych-wise), but fantastic novel about family with elements of thriller and the history of psychopharmacology.

Rough Music / Notes On An Exhibition / Friendly Fire (all by Patrick Gale) - simply my favourite author, and his books are both devastatingly sensitive, and infinitely powerful (at least when it comes to describing the trials of family life).

Free Food For Millionaires by Min Jin Lee - my friends and I have all loved this.

Call Me By Your Name by Andre Aciman - romantic, heart-wrenching, escapist. Puts into words the often bizarre feelings that we've all experienced about another person, romantically, at some point. Full of longing and Mediterranean Summer heat.

Case Histories by Kate Atkinson - the first of the Jackson Brodie novels. A series of truly intriguing mysteries, all involving Jackson Brodie, the only literary detective I have ever really warmed to, or see as anything more than one-dimensional.

What Was Lost by Catherine O'Flynn - this is one of the books I buy people as a gift. This story is so tragic, so involving and so funny, it's almost impossible that the author managed to combine all this into one book, but it is absolutely fantastic.

Others I recommend:

Wicked by Gregory Maguire. You must have heard of the musical that was based on this book? This book, is much darker and deeper than the show, but just as wonderful.

The Poisonwood Bible by Barbara Kingsolver(sp?). I read this over a very hot summer in my younger years and I felt the heat of the Congo resonate with the heat of my summer. Haven't gone back to it in ages, but I loved it then.

Middlesex by Jeffrey Eugenides. Greek hermaphrodite. Saga. Does it get better?

Shadow of the Wind, Carlos Ruiz Zafon a GREAT READ.

The Book Thief - Marcus Zusak. Or We Need to Talk About Kevin by Lionel Shriver. Both stayed with me after reading them.

Never Let Me Go - Kazuo Ishiguro

Remains of the Day - Kazuo Ishiguro

Tam Lin - Pamela Dean

The Wild Swans - Peg Kerr

Three Cups of Tea - Greg Mortenson

Persepolis (graphic novel) - Marjane Satrapi

Time Traveler's Wife - Audrey Niffenegger

In the Land of Invisible Women: A Female Doctor's Journey in the Saudi Kingdom - Qanta Ahmed

A Long and Fatal Love Chase - Louisa May Alcott

Welcome to the Monkeyhouse - Kurt Vonnegut

I also agree with the suggestions for Oryx & Crake, Snowflower, and The Curious Incident.

Try anything by Anita Shreve

If you're looking for something girly, anything by Jennifer Weiner is good. I really liked "Little Earthquakes" and right now I'm reading "Certain Girls" and I'm totally caught up in it.

If you want something to take you out of this world I would try reading Tamora Pierce, she writes children's/young adult fantasy and even as an adult I love it. It's my comfort reading. I'd recommend starting with "Alanna the First Adventure" or "First Test". It's all nights and magic and fun. There's also "The Mists of Avalon" by Marion Zimmer Bradley if you like Camelot type books. And of course, Madeline L'Engle is always good.

If you're looking for something with suspense, I recommend reading Arthur Hailey. They're older books so the context is a little out of date, but I can never put them down. Same thing with Michael Crichton, for him, I recommend "The Andromeda Strain".

I loved these:
"The Kite Runner" by Khaled Hosseini gives a wonderful look into the mind of an immigrant from a strife-tron country. Lots of action, lots of introspection, guilt, atonement.

"The Curious Incident of the Dog in the Night-Time" by Mark Haddon
If you read this you can combine psychiatry with reading a novel. The narrator is autistic and goes about solving a murder mystery. Light. Fun reading.

"Snow Flower and the Secret Fan" by Lisa See Engrossing tale from a female perspective of life in 19th century China. Wonderfully rich descriptions.

"The Joy Luck Club" by Amy Tan
Maybe everyone has already read this, but if you haven't this is a "can't put it down" novel intertwining modern Chinese-American life with historic Chinese life, culture.

" The Hidden Life of Dogs" by Elizabeth Marshal Thomas: For dog lovers only: This is not a novel, but reads like one, if you love dogs.

"Marley and Me" by John Grogan
For dog lovers only: This is autobiographical not a novel, but funny and light except for the ending. Heart-warming.

1. Oryx and Crake by Margaret Atwood
2. Old Man's War by John Scalzi
3. World War Z: An Oral History of the Zombie War

I just finished Time and Again by Jack Finney- it mixes history and time-travel, and I loved it.

For something lighter and brighter, I go to Terry Pratchett. A mixture of fantasy-humor-social commentary.

Spirits need lifting? Try The Shack by William Young- haven't read it, but have read great things about it.
Dune I found quite compelling.


I am just about to finish what very well may be the best book I have ever read. It is called "The Shadow of the Wind" by Carlos Zafon... I promise you won't be sorry!

Great blog, by the way!

Have you read Life of Pi by Yann Martel? Boy and Tiger get stuck in a life raft in the middle of an ocean... It's fabulous reading - I think I've read it 9 or 10 times now... and I may just need to read it again soon.