Dr Beech 🌤

Thesis: The worried well get too much therapy. Antithesis: A lot of people kill themselves, or attempt to, who have no history of mental health diagnoses, and who do not meet criteria for a DSM disorder at the time of their attempt. I don't know the exact number, but it's

surely OCD has a neurological basis? this tic-like, compulsive behavior? OCD-suffers are trapped in a labyrinth of pointless repetition; a living nightmare. feeling much sympathy for those so afflicted & for their long-suffering families.

“If a child’s parents are bad objects, he cannot reject them…for he cannot do without them.” Listen i like analytic ideas but this is lazy horseshit fantasizing about what is “normal” or typical. The idea that kids “have to ‘need’ their parents” is empirically not true. Many kids dissociate and learn not to need objects. Many kids are autistic. Many kids have (early) antisocial tendencies. Other infants might be more extroverted and narcissitic in their temperament, and not care about objects. Others are unintelligent (memory deficits) and not able to be aware of how “bad” an object the parents are. Various types of internal dynamics exist and not all infants have the same hardware and software for “needing” an external object.

A very special episode on the art and science of psychological healing ft. dr Irene hurford. What it is to treat psychosis, to treat brain and mind, to grow the soul. From pharmacology and ontology and back again! Please share! Very proud of this one! youtu.be/qXZ0RoUrHYY?si=_qrb…

I generally agree. Understanding developmental issues, introjects, object relationships, narcissistic injuries, etc. can be very helpful. The only issue is: We don’t have reliable categories of developmental stages or tasks. We have vague abstractions like “object permanence,” but even then, under stress people can “regress.” What do we do? Count the number of hours a person can “mentalize consistently”? In what situations? All we have are vague and unreliable abstractions, prone to giving the clinician the freedom to fantasize and fill in the gaps with whatever WISHES THE CLINICIAN HAS ABOUT THE PATIENT AND THEIR CIRCUMSTANCES. Fin

Here is my best attempt to simplify and clarify a Winnicottian perspective on psychopathology, development and therapy. It is highly compatible with neuropsychoanalysis I think, but also ideas from all corners of psychoanalysis (perhaps even French!)

I get that therapists who just start didactically lecturing a male stoic patient to be less stoic is not helpful and can actually be harmful. But these ideas sound suspiciously like colluding with the very elements in the psyche that are the -according to the essay- very prob 1/

“Their symptom is the most real thing that many people have.” -Lacan

It’s not quite real paradox but it is striking that being psychologically healthy is partially or even mostly constituted by being aware that you are NOT so psychologically healthy in various ways. The most sophisticated way to try to deny this is moralistic. “I am not

Psychedelics will be the first mental health therapy you aren’t prescribed to take for life. That’s bad for the pharmaceutical business model but very positive for patients. The researchers and philanthropists who got us here are heroes.

Everyone knows the Lindsay Clancy case. Almost nobody knows this one, and the reason why should stop you cold: when a mother dies alongside her children, there is no trial, no media coverage, and no one digs into what happened in the months before. Tranyelle Harshman was a 32-year-old Wyoming mother of four. No history of violence. No suicidal history. Her husband describes a loving mother and an incredible wife, and he is standing by her, just like Lindsay Clancy's husband. There was no affair, no conflict, no motive. I searched. What there was, according to the Wall Street Journal's reporting and the wrongful death lawsuit her mother has filed, was take-home ketamine prescribed for postpartum depression. When Tranyelle reported heart palpitations and feeling disconnected from reality for days, she was reportedly told it often gets worse before it gets better, and her dose was increased. After taking that increased dose, she shot her four daughters and then herself. Toxicology reportedly showed ketamine at four times the threshold associated with mind-altering effects. I helped develop a ketamine-based drug during my time in pharma. I know these side effect tables: dissociation in nearly half of patients, hallucinations, agitation, fear. This is why ketamine is normally given under clinical supervision, not at home, alone, with children napping upstairs. The pattern from the Clancy case is identical. A struggling mother reports that a drug is making her worse, and the answer is a higher dose. I will keep saying this until it changes: when a patient gets worse on a psychiatric drug, that is information, not impatience. You do not double down on it.