"Diagnostic revision may correct error; it may also threaten identity, access to support and self-understanding, fall unequally on particular groups, or become a mechanism for rationing" pubmed.ncbi.nlm.nih.gov/4292… From @DrMariosAdamou et al. De-diagnosis is a rising topic.

When I started psychiatry 60 yrs ago, 500,000 patients were warehoused in disgusting state hospitals. Things now much worse: 1)Only 100,000 psych beds 2)1/2 severe patients are untreated 3)400,000 in jail 4)500,000 homeless Richest country in world has very worst psych care.

Here's a first... benzodiazepine prescriptions declined in the past decade. Lower rates among all clinicians except one group - that I suspect is due to workforce shifts: psych-partners.com/benzodiaz…

Sometime before 2016, a psychiatrist started asking their late-diagnosed adult patients with ADHD whether they thought they were more sensitive to rejection and failure than other people. They said that they were. He didn’t (as far as I can tell) do any comparison with people with mental health problems, or with those with social anxiety. He didn’t look at children or those diagnosed in childhood. He just asked his patients to self-compare with others. There were no attempts to test out whether this was specific to ADHD, nor universal in those with ADHD. In 2016, the psychiatrist, William Dodson, gave this a name - rejection sensitivity dysphoria - and started writing about it. It resonated with influencers who created content talking about their RSD. It quickly multiplied. Articles were written about it on official sounding websites. Qualitative research was done, asking people who had heard about RSD whether they experienced it and what it was like. By 2024, Dodson was saying that RSD was neurological and genetic, not related to trauma and wouldn’t respond to psychotherapy. By 2026, bestselling author Alex Partridge wrote a whole book about his RSD, pinning it squarely to ADHD and saying that RSD ‘explained my entire life’. He gave a convincing sounding brain-based explanation about ‘glitches’ in how the ADHD brain processes dopamine and nor-epinephrine, and how these lead to rejection feeling far more brutal than for people without ADHD. There is no evidence of this that I have found. And in this way a psychological and emotional reaction was framed as a neurobiological symptom. Millions started to think that perhaps they had ADHD, because they were sensitive to rejection and failure. RSD spread, and soon people started saying it was part of autism too. Why does that matter? Because when people think something is due to how their brains work, they think that it is set in stone and won’t change. They think that medication is their only option, and that psychotherapy has nothing to offer. Emotional sensitivity is a really common psychological symptom, and it hasn’t been shown that it’s uniquely part of ADHD. RSD is an example of how neurodivergence is expanding to incorporate emotional reactions, and in the process turning psychology into neurology. With RSD, the most basic scientific questions haven’t been answered, but you’d never know that from what you see online. There, it all seems so certain and clear. It’s not.

If the goal is to set up medications for serious mental illness to succeed, they should be prescribed not in isolation but as part of a biopsychosocial package. 🔗👇 @adrianpreda

SAINT (SNT) TMS once promised outsized recovery rates for refractory depression, but two new trials from independent centers bring it back to earth: psych-partners.com/a-setback… Thanks for the find @RecoveryDoctor