Difficult-to-treat depression
Why “treatment resistant” may be the wrong frame—and how difficult cases should make clinicians think harder rather than patients lose hope.
Freckenhorst baptismal font, late 12th centuryCollegiate Church of St. Boniface, Warendorf, Münster, Germany · Read article ↗PSYCHIATRY · EVIDENCE · HUMAN PRESENCE
Psychiatry without dogma.
Notes for patients, families, clinicians, and curious readers on what psychiatry knows, what it routinely oversimplifies, and how to think clearly when there is no clean algorithm.
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Latest writing
Notes, guides, and essays.
Supplements Without Reinventing the Wheel
Why I ask about supplements—and why I am making Chris Aiken’s carefully curated guide easier for patients to use.
Read the note ↗The Art of Being a Failure as a Therapist
What Jay Haley’s 1969 satire still teaches psychiatrists—and perhaps every physician—about the habits that make care fail.
Read the essay ↗Psychopharmacology without camps
Practical reasoning about benefit, burden, discontinuation, recurrence, and why “drug good” versus “drug bad” is rarely a useful debate.
Neuromodulation without hype
Candidacy, targeting, protocols, outcomes, limitations, and the distinction between established treatment and promising investigation.
Measuring what matters
Why symptom scales are useful but incomplete—and why sleep, cognition, work, relationships, exercise, and autonomy belong in the outcome.
Clinical uncertainty
How experienced clinicians reason when the diagnosis is unsettled, the evidence is incomplete, and no treatment algorithm can make the decision.
Technology & human presence
Where artificial intelligence and measurement can help, what they cannot perceive, and why optimized language is not the same as an encounter.
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