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Articles by Nebyou Belay
We Are Physicians of Function, Not Functional Medicine
Everyone knows a narcissist. Their ex, their boss, their mother-in-law, a coworker who takes credit for other people’s work — the word has become the default explanation for anyone who is self-absorbed, difficult, or unkind. It shows up constantly in casual conversation and on social media, almost always applied by someone describing another person rather than by a clinician making a diagnosis.
Why Prostate Cancer Treatment Shouldn't Be a Binary Choice
There are moments in medicine when you realize that what you were taught is incomplete. Not necessarily wrong, but insufficient. Watching “The Pink Pill: Sex, Drugs & Who Has Control” was one of those pivotal moments. The topic of female sexual dysfunction is not new, but drastically overlooked. This documentary exposes the structural gaps, biases, and missed opportunities that have defined women’s health for decades, and I urge you to watch it, not just for yourself, but for your patients.
They suddenly exhibited psychiatric symptoms. It traced back to videos.
They suddenly exhibited psychiatric symptoms. It traced back to videos. (washingtonpost.com) They suddenly exhibited psychiatric symptoms. It traced back to videos. By Nebyou Belay 2026100810160400 In the spring of 2019, something unusual began happening at the Tourette's syndrome clinic at Hannover Medical School in Germany.
What Dermatologists See Before Psychiatrists Ever Do
How to Ensure Your Teaching Stays Relevant “See one, do one, teach one” — the vaunted mantra of the medical profession that describes learning, practice, and education as almost a single effort. But how linked are our study, work with patients, and our teaching? Are they different skills? And can we be equally effective with all of them? These questions are especially pertinent for my specialty, psychiatry.
Freezing Out the Scalpel: The Case for Cryoablation in Early-Stage Breast Cancer
By the time a patient with body dysmorphic disorder walks into a psychiatrist's office, a dermatologist or cosmetic surgeon has often already seen them — sometimes more than once, sometimes for the exact same complaint. Picture a composite, not-uncommon case: a patient convinced her nose is disfigured, though nothing about it looks unusual to anyone else. She's had two rhinoplasties already, each meant to fix what the last one supposedly missed.
What Dermatologists See Before Psychiatrists Ever Do
We Say Children Are Our Future, But Treat Their Health as Optional Every child is born with a basic need and right to healthcare. Yet whether that child receives timely preventive care, sees a specialist, or gets treatment before a disease becomes life-threatening depends largely on an accident of birth — what state they live in, whether their parents' employer offers insurance, or whether a family successfully navigates an ever-changing maze of eligibility rules.
What Dermatologists See Before Psychiatrists Ever Do
For over a century, the treatment of breast cancer has been defined by the knife. From Halsted's radical mastectomy to the modern era of breast-conserving surgery, the fundamental assumption has remained the same: the tumor must be cut out. However, a growing body of evidence now suggests that for a select group of women with early-stage, low-risk breast cancer, another option may provide similar outcomes.
What a psychiatric diagnosis means is not an explanation
When I tell a patient that she has major depressive disorder, something subtle happens in the room. What I mean and what she hears may be two very different things. I may mean that her symptoms meet an established set of criteria: depressed mood, loss of interest, changes in sleep or appetite, impaired concentration, and enough distress or dysfunction to cross a diagnostic threshold. She may hear something considerably stronger: The doctor has figured out what is wrong with me.
The autism spectrum diagnosis may be too broad a label
“I think I might be autistic.” “I hate eye contact.” “I get overwhelmed by loud noises.” “I’m really good at masking it.” Autism has become one of the most widely self-diagnosed conditions on social media, and for understandable reasons: Nearly everyone recognizes something of themselves in the traits now described online as autistic, disliking small talk, needing routine, having an intense interest, feeling drained after a party. None of that, on its own, is autism.
OCD misconceptions turn a serious illness into a quirk
“I’m so OCD.” “I think I’m a little OCD, I like things neat.” Clinicians hear versions of this constantly, said casually, sometimes as a joke, sometimes with a note of pride. The person is usually describing themselves as particular, exacting, or a little controlling. Almost none of it has anything to do with obsessive-compulsive disorder (OCD).
Mood swings and bipolar disorder are not the same thing
Few psychiatric terms have migrated into everyday language as completely as “bipolar.” It is now routinely used to describe irritability, emotional volatility, and rapid shifts in mood. Yet this widespread usage reflects a fundamental misunderstanding of the condition itself. At the center of the confusion is a mismatch of scale. The public conception of “mood swings” involves rapid fluctuation, changes occurring over minutes or hours.
Adult-onset ADHD is a naming problem, not a new disorder
“I’ve never really been able to focus, but it’s only become a real problem in the last few years, since I started this job. Could I be evaluated for adult ADHD?” I hear a version of this request often, and it captures a confusion built into the term itself. “Adult ADHD” sounds like it names a condition that begins in adulthood, the way adult-onset diabetes or adult-onset asthma can. It doesn’t, and it can’t. That is not a matter of clinical opinion; it is written into the diagnostic criteria.
Why there is no test for mental illness, and won’t be
A mother sat across from me recently, her twelve-year-old beside her, and asked a question I have heard in one form or another hundreds of times over two decades of practicing psychiatry: “Can we just get her tested? I want to know, scientifically, what she has.” She wasn’t asking for a diagnostic interview. She was picturing something closer to what happens elsewhere in medicine when a symptom is uncertain: a scan, a panel, a definitive number on a printout.
When mental health labels become part of who we are
Psychiatry occupies a place in public discourse that no other medical specialty does. Its language permeates everyday conversation, its concepts appear in film and literature, and its diagnoses are invoked casually in both social and digital spaces. No cardiologist or gastroenterologist encounters anything quite comparable. Psychiatry deals directly with the domains that define human experience: emotion, thought, behavior, and relationships.
Family history in psychiatry: Ask why, not whether
“My mother is bipolar. My brother has OCD. I’m sure this runs in the family.” I hear some version of this in nearly every intake, and I understand why. Family history is a genuinely powerful tool in most of medicine. It helps estimate genetic risk and sharpen diagnostic reasoning. In psychiatry, it’s often treated as carrying that same evidentiary weight. Too often, it doesn’t earn it. Disease broadly falls into two buckets: inherited and acquired.
Why a psychiatric diagnosis is not a biological target
“I have a lot of anxiety and stress. Can I get Prozac, Lexapro, or something like that?” “My moods are all over the place. One moment I’m happy, the next I’m sad, the next I’m enraged. Can I get a mood stabilizer?” I hear requests like these constantly. They’re completely understandable. They also reflect a common misunderstanding: that psychiatry works the way the rest of medicine does, where a symptom leads straight to a pill that fixes it.
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