Dear reader, what topics would you like me to write about?
Some of you have given me the gift of your attention for months, if not years. (Thank you!) I’m never sure what draws people back here to read my writing.
Now that I am clearly a “middle career” psychiatrist, I feel a duty to share what I know. This moment in time feels unstable. My professional niche seems atypical. It feels important to contribute what (little) I know in case it can help someone, somewhere. (Sharing what I know here also helps me improve my writing skills.)
So, I welcome your feedback and suggestions. What would you like to read here? What questions do you have? How can I be useful within this context?
Comments are open, so feel free to share your ideas there. You can also send me an e-mail at maria at mariayang dot org. If you’re reading this through the e-mail newsletter, you can reply to the e-mail.
A few reactions on topics related to psychiatry from the past week:
An example of a transitional object in baseball. The catcher for the Seattle Mariners, Cal Raleigh, did not play a few games due to injury concerns. Early in the game against the Atlanta Braves, the camera operator lingered on him in the dugout:
Notice that he’s not dressed to play. An unmarked bottle keeps him company. In his right hand is a baseball.
Transitional objects give us comfort and a sense of security. Maybe the baseball gave Cal comfort and security during his mandatory time off. (Some players can hold six or seven baseballs in one hand. That’s probably more about showing off!)
The MAHA Action Plan to Curb Psychiatric Overprescribing. Per the HHS press release:
HHS Secretary Robert F. Kennedy, Jr. laid out a new action plan to promote appropriate psychiatric prescribing and drive deprescribing when clinically indicated.
Does “inappropriate” psychiatric prescribing happen? Yes. Does deprescribing, whether clinically indicated or not, already happen? Yes.
When people think about medication management, they often think only of adding medications or exchanging one for another. Medication management also includes helping people come off of medications.
Many psychiatrists practice “deprescribing”. In 2019 I wrote about the ongoing difficulties in treating psychosis. There I commented on my own deprescribing experiences:
One of my early jobs was working in a geriatric adult home. My work there taught me that people with psychotic disorders can and do get better. The burdens of antipsychotic medications—paying for medications, the actual act of swallowing the pills every day, the side effects, some mild, some intense—add up. I was fortunate to work with some people to successfully reduce the doses of their antipsychotic medications and, in some cases, stop them completely! (There [was] also at least one instance when tapering medications was absolutely the wrong thing to do; that person ended up in the hospital. I felt terrible.)
Psychiatry is an easy target. Psychiatric medications, especially antidepressants, are common prescriptions. Many factors contribute to this: Health care appointments are short. (There’s not enough time for deep conversations.) It’s hard to access non-medication treatments. (Most rural areas do not have experts in evidence-based therapies.) Emotion literacy is not where we all want it to be.
To be clear, I am not anti-medication. Psychiatric medications can not only save lives, but also improve quality of life. However, medications are not the only tool psychiatrists have to help people. Most of us do prescribe appropriately. (Some people are vexed when we decline to write prescriptions.) Many of us do deprescribe when clinically indicated. (Some people express anxiety when they want to stay on their medications.)
Maria Yang, MD 