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      <title>The Last Psychiatrist</title>
      <link>http://thelastpsychiatrist.com/</link>
      <description>Updated Tuesdays and Fridays

Wovon man nicht sprechen kann, daruber muss man schweigen</description>
      <language>en</language>
      <copyright>Copyright 2008</copyright>
      <lastBuildDate>Wed, 27 Aug 2008 10:51:57 -0500</lastBuildDate>
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      <docs>http://blogs.law.harvard.edu/tech/rss</docs> 

      
      <item>
         <title>What Happens If Pharmaceutical Marketing Disappears? Part 1</title>
         <description><![CDATA[<br />Everyone (including me) thinks Pharma is too heavily involved with the practice of medicine.&nbsp; So we try to think of ways to stop this.&nbsp; Restrict gifts and consultant fees to doctors; decrease, or at least separate, industry funding from research; and, of course, no more reps in doctors' offices.<br /><br />These all sound like great ideas, how could you even come up with an argument against any of them?<br /><br />Here goes.<br /><br />As a bonus, I even offer a practical long term solution.<br />]]></description>
         <link>http://thelastpsychiatrist.com/2008/08/what_happens_if_pharmaceutical.html</link>
         <guid>http://thelastpsychiatrist.com/2008/08/what_happens_if_pharmaceutical.html</guid>
         <category>Psychiatry Gone Awry</category>
         <pubDate>Wed, 27 Aug 2008 10:51:57 -0500</pubDate>
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      <item>
         <title>If You&apos;re Watching, It&apos;s For You</title>
         <description><![CDATA[<br /><br />On the Late, Late Show With Craig Ferguson, a joke about "man-ginas," a few drug/DUI references, a Kristy Ally fat joke ("uses her swimming pool to cook spaghetti") and a homosexual reference.<br /><br />And I think about how TV has changed, things unimaginable 20 years ago are routine now.&nbsp;&nbsp; I guess they'll do anything to get the coveted youth demographic.<br /><br />And then I think, wait a second... <br /><br />]]></description>
         <link>http://thelastpsychiatrist.com/2008/08/if_youre_watching_its_for_you.html</link>
         <guid>http://thelastpsychiatrist.com/2008/08/if_youre_watching_its_for_you.html</guid>
         <category>Relationships and Family</category>
         <pubDate>Wed, 20 Aug 2008 13:17:42 -0500</pubDate>
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      <item>
         <title>Ara Abrahamian Wins Award For Medal Toss, Saved By Passport</title>
         <description><![CDATA[<br /><span class="mt-enclosure mt-enclosure-image" style="display: inline;"><img alt="ara.jpg" src="http://thelastpsychiatrist.com/images/ara.jpg" class="mt-image-none" style="" width="135" height="84" /></span><br /><br />Between 1am and 9am, a previous 2 paragraph version of this post managed to offend Swedes, Armenians, wrestlers, the Olympics, bronze medals and mats.<br /><br />In the interest of completeness, I will this time include the French.<br /><br />]]></description>
         <link>http://thelastpsychiatrist.com/2008/08/ara_abrahamian_wins_award_for.html</link>
         <guid>http://thelastpsychiatrist.com/2008/08/ara_abrahamian_wins_award_for.html</guid>
         <category>Politics</category>
         <pubDate>Fri, 15 Aug 2008 00:30:46 -0500</pubDate>
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      <item>
         <title>Seroquel For Bipolar Maintenance</title>
         <description><![CDATA[<br /><br /><br />A brief history of the past decade.<br />]]></description>
         <link>http://thelastpsychiatrist.com/2008/08/seroquel_for_bipolar_maintenan.html</link>
         <guid>http://thelastpsychiatrist.com/2008/08/seroquel_for_bipolar_maintenan.html</guid>
         <category>Clinical</category>
         <pubDate>Thu, 14 Aug 2008 14:21:10 -0500</pubDate>
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         <title>Drug Reps From Congress To Detail Doctors</title>
         <description><![CDATA[<br /><br />Oh, my God, I hope you're lying down for this.<br />]]></description>
         <link>http://thelastpsychiatrist.com/2008/08/drug_reps_from_congress_to_det.html</link>
         <guid>http://thelastpsychiatrist.com/2008/08/drug_reps_from_congress_to_det.html</guid>
         <category>Insurance Companies</category>
         <pubDate>Wed, 13 Aug 2008 15:19:27 -0500</pubDate>
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         <title>A Trip You May Have Taken </title>
         <description><![CDATA[<br /><br />He pulls over at the curb.&nbsp; All the shades are pulled down, the house looks dead.&nbsp; The house-- shack-- is on the beach. <br /><br />He gets out of the car.<br /><br />"Tracy," he calls out, expecting nothing.&nbsp; <br /><br />He
walks to the screen door. &nbsp; It's locked, but the inside door is wide
open.&nbsp; He smells pot, and something that is not pot, and something that
is feces.&nbsp;&nbsp; He has never seen this place, yet it is, somehow, exactly
as he imagined it would be.&nbsp; It is also worse.<br />]]></description>
         <link>http://thelastpsychiatrist.com/2008/08/a_trip_you_may_have_taken.html</link>
         <guid>http://thelastpsychiatrist.com/2008/08/a_trip_you_may_have_taken.html</guid>
         <category>Relationships and Family</category>
         <pubDate>Tue, 12 Aug 2008 13:47:56 -0500</pubDate>
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         <title>The Hidden Zero Effect</title>
         <description><![CDATA[<br />Choose:<br /><br /><i>$5 today or $10 in a year.</i><br /><br />]]></description>
         <link>http://thelastpsychiatrist.com/2008/08/the_hidden_zero_effect.html</link>
         <guid>http://thelastpsychiatrist.com/2008/08/the_hidden_zero_effect.html</guid>
         <category>Money</category>
         <pubDate>Mon, 11 Aug 2008 14:16:22 -0500</pubDate>
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         <title>Craig Ferguson, The Jonas Brothers, and Katy Perry</title>
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<p style="margin-bottom: 0in;">This is what 46 year old Scottish late night TV
host Craig Ferguson said Tuesday night:</p>
<p style="margin-bottom: 0in;"><br />
</p>
<blockquote><p style="margin-bottom: 0in;">The Jonas Brothers... I'm sure they're
fine young kids, and their music's not for me, it's for young people,
I understand that, but my point is-- they're kind of too clean.  With
the purity rings, symbolizing that you're saving yourself for
marriage.  Now, I'm thinking-- what kind of a rock star is this? 
What kind of a rock star is this?...</p><br />
<p style="margin-bottom: 0in;">It makes me a little uncomfortable,
it's a little sinister to me, when the teenage rebellion is
controlled and sanitized by a big corporation.  There has to be some
rebellion, or else it's not rock and roll.</p><p style="margin-bottom: 0in;"><br /></p></blockquote><p style="margin-bottom: 0in;"><br /></p><br />]]></description>
         <link>http://thelastpsychiatrist.com/2008/08/craig_ferguson_the_jonas_broth.html</link>
         <guid>http://thelastpsychiatrist.com/2008/08/craig_ferguson_the_jonas_broth.html</guid>
         <category>Movies, TV, and Books</category>
         <pubDate>Fri, 08 Aug 2008 10:26:58 -0500</pubDate>
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      <item>
         <title>A Little Bird Told Me</title>
         <description><![CDATA[<br /><br />1. McCain may drop out of the race-- running mate Romney to continue?<br /><br />2. Oil prices were pushed higher (Iran/Israel tensions, etc) by a concerted government effort to generate oil revenues for Iraq, promote greater stability so as to allow partial withdrawal of troops before election; and a subsequent reduction of oil prices to erase them as a campaign issue.&nbsp; Both Iran and Israel were in on the plan.<br /><br />Tin foil hat stuff, but thought I'd put it out there.<br />]]></description>
         <link>http://thelastpsychiatrist.com/2008/08/a_little_bird_told_me.html</link>
         <guid>http://thelastpsychiatrist.com/2008/08/a_little_bird_told_me.html</guid>
         <category>Politics</category>
         <pubDate>Wed, 06 Aug 2008 16:29:32 -0500</pubDate>
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      <item>
         <title>Social Welfare Is A Red Herring: The Return Of Feudalism</title>
         <description><![CDATA[<br />The policies sound good, and perhaps they would be, if not for the malignant intentions that motivate them.<br />]]></description>
         <link>http://thelastpsychiatrist.com/2008/07/social_welfare_is_a_red_herrin.html</link>
         <guid>http://thelastpsychiatrist.com/2008/07/social_welfare_is_a_red_herrin.html</guid>
         <category>Politics</category>
         <pubDate>Wed, 30 Jul 2008 14:39:39 -0500</pubDate>
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      <item>
         <title>Fifty Percent of Foster Kids Are On Psychiatric Medications</title>
         <description><![CDATA[<br />That's right.&nbsp; The single most best predictor of mental illness-- better than family history, better than genetics, better than symptomatology-- is being a foster child.<br /><br />Texas data: 2004, 40% of the 32,000 foster kids were on psychotropics. 2005 it was, by age:<br /><br /><ul><li>0-5: 12.4%</li><li>6-12: 55%</li><li>13-17: 66.5%</li></ul>Do you understand the significance of this?&nbsp; If you tell me every single person in your family, including your identical twin, has schizophrenia, I will not be able to tell you if you have it-- but if you tell me <i>simply</i> that you are a foster child...<br /><br />I'm sure someone has an explanation that deals with 5HT-2a receptors, or the amygdala, or genes on chromosome 12, but:<br /><br /><blockquote><span class="article-text">"<span id="10168_1167042_1.0">When two-thirds
of foster care adolescents receive treatment for emotional and
behavioral problems, far in excess of the proportion in the non- foster
care population, we should have assurances that the youth are
benefiting from such treatment</span></span>," <a href="http://www.psychiatrictimes.com/display/article/10168/1167042">said Dr. Zito.</a><br /></blockquote>Damn right. But as I said in my <a href="http://thelastpsychiatrist.com/2008/07/esmin_green.html">Esmin Green article</a> that failed to convince anyone, this will never really be explored because society doesn't have any other options. &nbsp;&nbsp; If you don't call 16,000 Texas kids "early onset bipolar," does the system have a Plan B?&nbsp; Jail, I guess.<br /><br />]]></description>
         <link>http://thelastpsychiatrist.com/2008/07/fifty_percent_of_foster_kids_a.html</link>
         <guid>http://thelastpsychiatrist.com/2008/07/fifty_percent_of_foster_kids_a.html</guid>
         <category></category>
         <pubDate>Mon, 28 Jul 2008 14:17:41 -0500</pubDate>
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      <item>
         <title>Psychiatry is the pressure valve of society</title>
         <description><![CDATA[<br />In case you doubted, here is today's front page of USAToday: <a href="http://www.usatoday.com/news/health/2008-07-22-mental-health-finances_N.htm"><span class="inside-head">Economy's stuck, but business is booming at therapists' offices</span>.</a><br /><br />If that was the end of the story-- if people had social troubles and turned to psychiatry for help <i>because of those troubles</i>, it would be a good thing.&nbsp; Get help where you can.<br /><br />But the larger problem is that in going to psychiatry, their socioeconomic issues get demoted to "factors" and the feelings become pathologized.&nbsp; Psychiatry doesn't explain, it identifies.&nbsp; You're not depressed because you lost your house; you have depression, and one of the triggers is losing your house.&nbsp; See the difference?<br /><br />You'll say this doesn't happen all the time, maybe not even the majority of the time.&nbsp; But even if it doesn't happen to a specific individual, it still happens to enough people that it bolsters&nbsp; psychiatry's role as the necessary player in managing suffering of any kind.<br /><br />A 20% increase in therapy visits will be interpreted by psychiatry as a 20% increase in depression and anxiety.&nbsp; It will say depression has a prevalence of X, it will say it is underdiagnosed and undertreated, etc. And it will creep into the social consciousness that these are pre-existing diseases with triggers, not the consequences of external events.<br /><br />Society needs that illusion, it needs that lie, because it has created unrealistic expectations in people and no way of fulfilling them. &nbsp; Here's what a society looks like under the similar economic conditions, but without psychiatry:<br /><br /><blockquote><p class="inside-copy"><b>The absence of hope </b></p><p class="inside-copy">Today's popular frustrations over flat-lining
living standards have been building for years. The recent boom, felt
only by the already well-off, has done little to change that
discontent. Labor unrest has been growing for months; violent protests erupted... corporate taxes will be raised and gasoline
subsidies cut... The move was designed to
take the steam out of boiling anti-government sentiment.</p></blockquote><p class="inside-copy">The above article, also from USAToday, has a slightly different title: <a href="http://www.usatoday.com/money/world/2008-05-14-egypt-economy_N.htm"><span class="inside-head">Egypt's economy soars; so does misery</span>.</a></p>
<br /><br /><br />]]></description>
         <link>http://thelastpsychiatrist.com/2008/07/psychiatry_is_the_pressure_val.html</link>
         <guid>http://thelastpsychiatrist.com/2008/07/psychiatry_is_the_pressure_val.html</guid>
         <category>Psychiatry Gone Awry</category>
         <pubDate>Wed, 23 Jul 2008 10:02:55 -0500</pubDate>
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         <title>Being The Main Character In Your Own TV Show Is Sort Of A Delusion</title>
         <description><![CDATA[<br />Two psychiatrists, believe they have discovered a new, YouTube generation, delusion: believing you are in a <a href="http://www.nationalpost.com/news/story.html?id=665015">secret reality TV show.</a><br /><br />The article describes cases of people who believe they are secretly being filmed.&nbsp; <br /><br /><blockquote>"I realized that I was and am the centre, the focus of attention by
millions and millions of people," explained one patient, an army
veteran who came from an upper-middle-class upbringing."My
family and everyone I knew were and are actors in a script, a charade
whose entire purpose is to make me the focus of the world's attention."<br /></blockquote>The belief that they are being filmed certainly gives the person a sense of importance, or worth
independent of and beyond the mundane life he lives in.&nbsp; In
other words, it allows for an inflation of identity without actually
having to do anything.&nbsp;&nbsp; Call it grandiosity<br /><blockquote><br />The patient added that he planned to climb to the top of the Statue of Liberty, and if his true love were
waiting for him, the puppeteer strings would be cut. If she failed to
show up, he would jump to his death.<br /></blockquote><br />Grandiosity
is one explanation, but I submit that the important part of this
delusion isn't the filming, but the "puppeteer."&nbsp; The delusion isn't
about self-importance, but rather an explanation for powerlessness.&nbsp; <i>I am being manipulated by the outside.&nbsp; There's nothing I can do.</i><br /><br />Consider
that a delusion which enhances your importance might not be one you'd
want terminated; but these cases have the termination of the delusion
built in.<br /><br />In "reality" (ha!) such cases are cognitive metaphors
for maturity.&nbsp; Only when you gain sufficient self-awareness and
autonomy can you break away from the artificial, manipulated reality of
adolescence.<br /><br />"But these guys are 30 years old!"&nbsp; Exactly.&nbsp; Real
adolescents don't need a delusion to tell them they're powerless.&nbsp; But
a 30 year old should be dealing with intimacy vs. isolation, but
instead they're stuck back at identity vs. role confusion.<br /><br />The
delusion is the protection, not the empowerment.&nbsp; It says, "don't
worry, you haven't accomplished anything because the producers haven't
put that into the script yet."&nbsp; Ultimately, this YouTube delusion is
the result of a fleeting awareness that you cannot choose your identity
unless you back it up with actions-- that actions are identity.<br /><br />When
a narcissist has this awareness, he has two choices.&nbsp; He can retreat
into a protective delusion, such as this one; or he can convince--
read: force-- someone else to accept his identity even in the absence
of actions.&nbsp; "I am a tough cop!&nbsp; Well, maybe not actually a cop, but if
something went down in this mall, I could be like a cop, and that's
just as good!"<br /><br />You do not want to be the person the <a href="http://thelastpsychiatrist.com/2006/12/if_this_is_one_of_the_sexiest.html">narcissist tries to convince.</a><br /> ]]></description>
         <link>http://thelastpsychiatrist.com/2008/07/being_the_main_character_in_yo.html</link>
         <guid>http://thelastpsychiatrist.com/2008/07/being_the_main_character_in_yo.html</guid>
         <category>Clinical</category>
         <pubDate>Tue, 22 Jul 2008 00:20:38 -0500</pubDate>
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         <title>Academics Hide Drug Company Payments</title>
         <description><![CDATA[<br /><br />And with good reason.<br />]]></description>
         <link>http://thelastpsychiatrist.com/2008/07/academics_hide_drug_company_pa.html</link>
         <guid>http://thelastpsychiatrist.com/2008/07/academics_hide_drug_company_pa.html</guid>
         <category>Psychiatry Gone Awry</category>
         <pubDate>Sun, 20 Jul 2008 23:57:21 -0500</pubDate>
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         <title>When CGI Porn Looks Real: Is Anyone Thinking About The Children?</title>
         <description><![CDATA[<br />Making the internet rounds is a post written by <a href="http://debbienathan.com/2008/04/30/a-day-with-the-csi-folks-talking-about-virtual-child-porn/">Debbie Nathan</a>, (<i>Pornography: A Groundwork Guide </i>and <i>Satan's Silence: Ritual Abuse and the Making of a Modern American Witch Hunt</i>) on what the government is going to do when computer generated child porn becomes indistinguishable from actual photos.&nbsp; <br /><br />Other than freak out.<br /><br /><br />]]></description>
         <link>http://thelastpsychiatrist.com/2008/07/when_cgi_porn_looks_real_is_an.html</link>
         <guid>http://thelastpsychiatrist.com/2008/07/when_cgi_porn_looks_real_is_an.html</guid>
         <category>Legal Issues</category>
         <pubDate>Thu, 17 Jul 2008 00:51:24 -0500</pubDate>
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