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Articles by David Rettew M.D
Psychiatry: In the Crosshairs, at a Crossroads
This is not an anti-psychiatry post. I love my profession. I have seen it literally save lives and pull people out of very deep holes. But the very existence of psychiatry is under threat, and we are not responding in an effective way. My beloved colleagues, it is time for some tough love. We currently have psychologists doing this work with no medical training. We have nurses doing this work with no psychotherapy training.
Psychiatry: In the Crosshairs, at a Crossroads
Take our Depression Test Find a therapist near me The field of psychiatry is currently under threat, and we are not responding effectively. Psychiatrists need to move towards, not away from, the things that make us unique. Specific steps we can take include returning to more in-person care, and moving away from "med checks." This is not an anti-psychiatry post. I love my profession. I have seen it literally save lives and pull people out of very deep holes.
When No Psychiatric Diagnosis Seems to Fit
In medicine, we try very hard to turn the symptoms that people present with into a diagnosis that can help guide optimal treatment. It’s a system that sounds great but, in reality, often falls short. Despite the approximately 300 different mental health diagnoses contained within the Diagnostic and Statistical Manual (DSM) of Mental Disorders, it is extremely common that the clinical picture a patient/client describes doesn’t fit neatly into any of them.
When No Psychiatric Diagnosis Seems to Fit
Take our Depression Test Find a therapist near me It's common in treatment situations that a person's assigned diagnosis doesn't seem like a good fit. Psychiatrists may tolerate this ambiguity more readily than clients. A good conversation between client and clinician can help resolve some of the tension in this moment. Very often, major improvements can still occur even with diagnostic uncertainty.
Is Psychiatry Making America Unhealthy?
As expected, the US Health and Human Services Administration, led by Secretary Robert Kennedy, launched its “MAHA Action Plan to Curb Psychiatric Overprescribing” on May 4. On one level, the message resonates with many initiatives that mental health professionals, including myself, have been doing for years. There have long been concerns that psychiatric medications can be used too soon before things like therapy, family interventions, and health promotion activities.
Is Psychiatry Making America Unhealthy? - David Rettew M.d
Take our Depression Test Find a therapist near me There are many elements of this initiative that would be well received by mental health professionals. Unfortunately, the targeted audience for this campaign was left out and scapegoated. This initiative also ignores the perhaps even bigger problem of under-treatment. As expected, the US Health and Human Services Administration, led by Secretary Robert Kennedy, launched its “MAHA Action Plan to Curb Psychiatric Overprescribing” on May 4.
Psychiatric Nursing Students Can't Find Clinical Training
An ever-increasing percentage of psychiatric care in the United States is being delivered by Psychiatric Mental Health Nurse Practitioners (PMHNPs). To earn this credential, one must first get a nursing degree. Then, the most common path is to obtain a Masters of Science in Nursing with a psychiatric specialization.
Big Changes to Psychiatric Diagnoses Are Coming, Maybe
Every decade or so, the official definitions of mental health diagnoses like bipolar disorder, schizophrenia, and ADHD, change, and that time is coming around once again. The mechanism through which these modifications happen is through a book, published by the American Psychiatric Association, called the Diagnostic and Statistical Manual of Mental Disorders, otherwise known as the DSM.
Is This Mental Health Prevention or Treatment?
Being able to prevent the onset of mental health problems is a critical need. Unlike in some other areas, the distinction between prevention and treatment in mental health is less clear. Many research studies that claim to focus on prevention actually have many components of treatment. It is worthwhile to separate these areas better and look for possible differences.
Are Mental Health Clinic Audits Asking the Wrong Questions?
Mental health clinics of all types, particularly large facilities that receive public support, are subject to quite a bit of oversight and regulation from many different organizations. These can include state health and mental health departments, insurance companies or coordinated care organizations (CCOs), federal agencies like the Centers for Medicare and Medicaid, and other groups.
Are Mental Health Clinic Audits Asking the Wrong Questions? - David Rettew M.d
Mental health clinics of all types, particularly large facilities that receive public support, are subject to quite a bit of oversight and regulation from many different organizations. These can include state health and mental health departments, insurance companies or coordinated care organizations (CCOs), federal agencies like the Centers for Medicare and Medicaid, and other groups.
The Shifting Rates of Youth Psychiatric Diagnoses
The rates of various psychiatric diagnoses as applied to children and adolescents can change quite a bit over time for various reasons. There is much debate about the increased prevalence of diagnoses such as autism and ADHD over the past 30 years or so. In the 1990s and early 2000s, there was also a dramatic and controversial increase in the number of youth being diagnosed with bipolar disorder in part due to a shift in how the disorder was conceptualized by mental health professionals.
Parenting Is the Most Ignored Area of Youth Treatment
Mental health professionals who work exclusively with adults commonly half-joke that the choice not to work with children and adolescents was based less on a desire to avoid working with kids themselves and more on a desire to avoid having to work with parents. Unfortunately, many of us who have chosen to dedicate our career to helping youth often miss, or actively avoid, opportunities to engage directly about parenting issues. This is not due to a lack of importance.
Core Influences on Youth Mental Health Haven’t Gone Away
While the rise in youth mental health problems has been widely appreciated, there remains a lot of debate about what specifically is behind it. Many popular articles and books implicate some more modern era suspects, specifically, 1) smartphones, 2) helicopter parenting, and 3) ongoing effects of COVID.
Core Influences on Youth Mental Health Haven’t Gone Away - David Rettew M.d
While the rise in youth mental health problems has been widely appreciated, there remains a lot of debate about what specifically is behind it. Many popular articles and books implicate some more modern era suspects, specifically, 1) smartphones, 2) helicopter parenting, and 3) ongoing effects of COVID.
Being Orderly Is Not OCD
Lately, on social media and other internet outlets, there’s been a surge of content related to people with various mental health conditions feeling slighted about the casual use of clinical terms to describe non-clinical behaviors and states of mind.
Being Orderly Is Not OCD - David Rettew M.d
Lately, on social media and other internet outlets, there’s been a surge of content related to people with various mental health conditions feeling slighted about the casual use of clinical terms to describe non-clinical behaviors and states of mind.
Prescriber, Provider, and Other Titles Doctors Despise
When my clinic decided to switch our electronic medical record vendor, I tried to use whatever little clout I had as the psychiatry leader of our organization to respectfully ask that terms like “prescriber” and “medication management” be stricken from the platform. It was to no avail. In the end, we were just a small cog in their big company. Now every time I log in, I am reminded of my designation as a prescriber.
Telehealth Is Getting Out of Control
I used to be a big fan of telemedicine. Nearly 20 years ago, even before the iPhone (if you remember that era), I was involved in pilot programs using telemedicine to improve access to psychiatric care in rural areas. People liked it, and people continued to fiddle with telehealth projects for many years. Then came COVID and mental health services pivoted on a dime, with just about everyone delivering care through telemedicine whether they wanted to or not — and thank goodness we had this option.
More Turkey Anyone? Tips to Smooth Family Political Debates
This year, the holiday season came immediately after our presidential election, so you can bet that the political feelings that usually run hot during holiday family gatherings might notch up even further this year. If you are one of the many people who are already dreading the impending political squabbles that can quickly turn a friendly family gathering into an intense and awkward debate, now is the time to start planning ahead.
More Turkey Anyone? Tips to Smooth Family Political Debates - David Rettew M.d
Aa Aa Aa - A + This year, the holiday season came immediately after our presidential election, so you can bet that the political feelings that usually run hot during holiday family gatherings might notch up even further this year. If you are one of the many people who are already dreading the impending political squabbles that can quickly turn a friendly family gathering into an intense and awkward debate, now is the time to start planning ahead.
Supply of Youth Psychiatric Hospital Beds Not Improving
As the number of youth who report significant mental health problems continues to rise, it would be at least somewhat reassuring to know that the capacity to treat these problems is also rising. Unfortunately, when it comes to youth needing psychiatric hospitalization, that does not seem to be the case, particularly if you live in certain states.
Are My Meds Working Really Well or Do I No Longer Need Them? - David Rettew M.d
Aa Aa Aa - A + Medications, along with psychotherapy, healthy activities, and other interventions, can make a lot of people feel better. This is obviously a good thing, but after some time can set up an important but difficult question. When someone is taking medications and feeling back to normal after a period of months or even longer, a logical question often arises: Am I feeling better because these medications are working really well, or because they are no longer needed?
Don’t Forget About Vital Signs in Psychiatry Visits
These days, an increasing proportion of psychiatric care is being delivered online through various telemedicine platforms and organizations. There are certainly some practical advantages to this growing trend—but there are also some potential hazards that need to be carefully considered by psychiatric clinicians who deliver care and the patients and clients who receive it.
Our Biggest Mistakes When Debating Mental Health - David Rettew M.d
Aa Aa Aa - A + Mental health is a topic of a lot of public debate. As an area that infuses science, politics, philosophy, morality, law, and many other areas, it is easy to see why. These debates and controversies can get heated, which to some degree is unavoidable but, in others, is becoming an increasingly tiresome product of rigid and oversimplified thinking that we would all do well to move on from.
Behavioral Health or Mental Health? Which Is It?
The terms mental health and behavioral health are often applied when it comes it our thoughts, emotions, and behaviors as well as specific diagnoses such as depression or schizophrenia. What is confusing to many, however, is that it seems like some individuals and groups attach different meanings to behavioral versus mental health, while for others the terms are completely interchangeable and it’s just a tomato tomAHto thing. Behavioral health is clearly a newer term compared with mental health.
The Outsourcing of Mental Healthcare to the Public Sector - David Rettew M.d
Who should be delivering healthcare? Private companies? The government? The debate over what works best will go on for years. As it continues, what clearly isn’t working is this strange hybrid situation we current have in which some aspects of healthcare are predominantly within the private world (including “not for profit” organizations that operate very much like private entities) while others are much more likely administered by federal, state, and local governments.
The Mental Illness-Violence Link
Advocates push the position that mental illness is the primary cause of violent actions—or a non-factor. Decades of research find a more complex association between mental illness and violence. Questions about what should count as mental illness have clouded the debate. Substance use, poverty, and other factors increase the known association. The recent shooting in Jacksonville has predictably renewed the public debate on violence and mental illness.
Colic in Infancy May Be More Than Just Gas
Key points Excessive infant crying or colic is a common problem that is often thought to be self-limiting. A recent study found an association between excessive infant crying and later behavioral challenges. Excessive crying was also found to be linked to a smaller volume of the amygdala. Babies cry. Some, however, cry a lot and seem less able to be soothed.
Social Media Use and 'Divergent' Brain Development
Key points Excessive screen and social media use are often implicated as a reason for declining mental health in youth. A recent study found an association between brain activation patterns over time and amount of social media use but firm conclusions were limited. We don't need to wait to design ways to help youth regulate screen time and social media usage.
Houston, We Have a Cannabis Problem
For years, the opioid crisis has been the leading concern when it comes to substance use. There’s certainly good reason for this emphasis, but as a result, the harms associated with other drugs have successfully been able to avoid the spotlight. In my view, cannabis use is now the biggest contributor to mental health and substance use problems that, up until quite recently, nobody was talking about.
Why Are Introverts So Resilient?
The Introvert's Advantage? By David Rettew M.D. How personality traits may influence resilience.
The Surgeon General’s Call to Action on Child Mental Health
The Surgeon General of the United States, Dr. Vivek Murthy, recently released an advisory report on the current state of youth mental health along with recommendations to improve well-being.
Psychiatric Help: The Doctor Is...Online
You’ve likely seen the commercials that advertise getting some small sliver of healthcare through a online company that specializes in just. . . erectile dysfunction treatment, birth control, etc. Most of these upstarts seem to identify some small but profitable niche in medicine where they can skim off their piece and leave the rest of the patient to someone else.
Your Brain, On Spanking
The use of spanking and corporal punishment as a form of parental discipline has declined a bit over the years but overall has remained remarkably stable, especially given the fewer and fewer parenting and child mental health experts who advocate for the practice. The dwindling support for corporal punishment comes from a growing body of research demonstrating that it is not particularly effective and leads to more rather than fewer behavioral and mental health problems down the road.
An Introvert Advantage During COVID?
Personality traits have been shown to be strong predictors of health and well-being. They’ve also been shown to be important components of resilience and one’s ability to cope with stressors. Overall, people who are more active and lively (i.e. extraverted), less worried, more persistent, and have better abilities to regulate their thoughts and behaviors tend to fare better under duress. Indeed, this combination has even been referred to as the “Resilient” personality profile.
Did Introverts Have an Advantage During COVID?
New research suggests that extraverted people experienced lower moods during the pandemic, while introverted people experienced slightly higher moods than usual. Decreases in mood were larger for people low in neuroticism than people high in neuroticism. The findings demonstrate that personality traits can produce surprising benefits in certain situations. Personality traits have been shown to be strong predictors of health and well-being.
Parent Unnaturally? Making Sense of Some Strange Advice
One of the central themes of recent posts and of my new book is that parenting is not a one-size-fits-all endeavor. Many parents already know this, but for some reason this reality has escaped much of the parenting advice found in books, blogs, and articles that tend to deliver recommendations as though all kids and parents are the same.
Do Kids Really Misbehave for Attention?
One of the ageless truisms in parenting is that attention-seeking is a primary motivation for a child’s bad behavior. If little Johnny smacks his sister, throws a tantrum, or takes that extra cookie, we are often instructed to see this action as a strategic play to get mom or dad to stop doing what they are doing and pay attention to Johnny. Even negative attention is preferable to no attention at all, the adage continues.
"It Depends" Parenting
It never ceases to amaze parents how the same approach to raising children can led to such different results. As a practicing child psychiatrist, I hear all the time how a particular parenting technique, like maybe a bedtime routine or rules about eating, worked so well for the first child and then failed spectacularly for the second. The struggle to find some new method or technique often pushes parents to look for answers in the world of books, blogs, and social media posts.
It Depends Parenting: Why One-Size-Fits-All Approaches Fail
It never ceases to amaze parents how the same approach to raising children can led to such different results. As practicing child psychiatrist, I hear all the time how a particular parenting technique, like maybe a bedtime routine or rules about eating, worked so well for the first child and then failed spectacularly for the second. The struggle to find some new method or technique often pushes parents to look for answers in the world of books, blogs, and social media posts.
Worried for Nothing?
Back in college, I used to row on our crew team. It was a pretty intense experience, and I had this habit of tensing up my shoulders, which in turn had the effect of draining some of the power in my rowing stroke. My coach, who would follow us along in a small motorboat, was quick to notice this flaw but unfortunately had a particularly untherapeutic method of getting me to fix it: yelling at the top of his lungs, “Relax Rettew!” with a BULLHORN.
Why We Parent the Way We Do
Why Parenting May Not Matter and Why Most Social Science Research is Probably Wrong: I want you to consider the possibility that your parents did not shape you as a person. Despite how it feels, your mother and father (or whoever raised you) likely imprinted almost nothing on your personality that has persisted into adulthood. Pause for a minute and let that heresy wash across your synapses. It flies in the face of common sense, does it not?
Psychiatric Vs. Neurological: Can the Brain Tell?
My last posting explored the question of whether or not autism should be considered a psychiatric disorder versus belonging to some other category (developmental, neurological, etc.). Right after the post came out, an interesting study appeared in the latest issue of the British Journal of Psychiatry. The study ambitiously tried to see whether or not they could find differences between disorders classically defined as being psychiatric versus neurological based on brain anatomy.
Why We Parent As We Do
There are billions of parents out there and each one unique in their approach to their individual children. For many of us, our methods are fairly instinctual and natural. That’s certainly not a bad thing, but it can be useful to take a step back and reflect on where our own parenting approach comes from and whether or not these influences are in the “proper” place when considered more carefully.
Psychiatry’s Balancing Act Between Coercion and Neglect
In case you haven’t noticed, criticism of mental health treatment and the field of psychiatry has turned up a notch. Listen closely, however, and you’ll realize that it comes from opposite directions. Neither of these channels is really new, but it does underscore the continued tension in trying to pull off a balancing act the mental health community has been walking for decades.
FDA Approves First Ever Video Game Treatment for ADHD
Up until now, video games have been seen more as the problem rather than the solution when it comes to attention skills in children and those who meet criteria for Attention Deficit Hyperactivity Disorder (ADHD). On June 15, 2020, however, the FDA gave approval for the first video game treatment, more technically called a “game based digital therapeutic device,” for the treatment of ADHD.
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