My message in a nutshell

DSC_6552-001I’m Dr. Paul Minot, a psychiatrist with over 28 years experience in medication-oriented practice. Psychiatric medications help many patients, but their benefits are immensely oversold by the psychiatric industry. Contemporary psychiatry routinely neglects the psychological and social factors that contribute to psychiatric disorders, and has created a vast body of pseudoscientific myth to promote medications as a panacea for complicated problems. This misinformation disempowers patients, and in doing so often prolongs the course of illness.

The history of psychiatry is littered with pseudoscientific hacks who, in the face of the impenetrable mystery known as the brain/mind, have simply made shit up to explain psychiatric disease. The current love affair with psychopharmacology is just the latest pendulum swing in our historical vascillation between biological and psychosocial explanations for disease–driven toward the biological apex in recent years by a modicum of clinical success, a whole lot of drug money, and a dollop of professional insecurity. This prevailing fashion is propped up by a bunch of diagnoses that are defined not by scientific confirmation, but by committee–and are used to cover up the unimaginable amount of ignorance we still have about the actual workings of the brain.

A cursory look at the computer as a model for the workings of the brain/mind reveals the folly of our single-minded embrace of biological explanations for psychiatric illness. Just as a computer has hardware and software components, both of which are essential for its successful operation, the brain relies on both biological and psychological components for its operations. The truth is that we know far less about biological components, and yet they are almost certainly less relevant than we make them out to be. The wish for a magic pill that does the hard work of curing psychiatric disorders is attractive to psychiatrists, the medical industry, and to patients–but it’s easier to sell than it is to deliver. More often than not it’s the promise of a hardware solution to a software problem. I‘ve dedicated this website and related activities, as well as my clinical practice, to overturning these pseudoscientific myths and promoting a more holistic view of psychiatric disorders and their treatment.

“Don Jon”: Worst date movie ever?

Don JonLast month I went to the opening night of “Don Jon”, the screenwriting and directorial debut of star Joseph Gordon-Levitt. As those who’ve seen the eye-popping trailer for this film already know, the title character really cares about his body, his pad, his ride, his family, his church, his boys, his girls…and his porn. (SPOILER ALERT: He really likes his porn. And I’ll be freely sharing my thoughts about this film, although I doubt the ending is much of a surprise.) The movie was sparsely attended at the local theater, with only five couples present (including my wife and me) when the movie began. Before a half hour had passed two of those couples had already left, and one more couple left later on. I wasn’t surprised to see this happen–but the question of precisely why it happened has engrossed me since. Continue reading

The language of emotion

Heart fighting brainBack in 1979, when I was a 3rd year medical student on surgery rotation at the Audie Murphy VA Hospital in San Antonio, I had the experience of working with an elderly man who had suffered a severe stroke of the left middle cerebral artery, causing him to have global aphasia. This unfortunate soul had advanced atherosclerosis manifesting as peripheral vessel disease, with resultant gangrene in his legs. He had already had above-knee amputation of both legs, and was subjected to repeated surgical debridement of his stumps due to advancing gangrene. He was presumed to be demented from his stroke, although it was difficult to determine how much so because of his grossly impaired verbal expression and comprehension. He was functionally nonverbal, unable to express his thoughts and feelings, or to understand others’ words. However he would make it clear to us how miserable he was when he was taken from his hospital bed and transported to the operating room for his near-weekly debridements. Not only was he agitated, but he would curse up a storm: “Shit!! Goddammit!! Oh shit!! Oh shit!! Goddammit!! F**k!!” This was the only kind of speech that I ever heard from him during my three weeks on the rotation. Continue reading

Enough of that, it’s time to get back to work!

Balance Life Work harmony on scalesAfter a 2-year hiatus, I’m returning to my writing and related activities. I’ve been through a lot of personal upheaval, most notably a prolonged separation and eventual divorce after 18 years of marriage. Along with the usual financial distress and family turmoil, I’ve made three moves, and even went through a 3-month period when I was technically “homeless” while staying with a couple of lovely friends. It’s all been a great test of my Buddhist faith, which really softened the blows. It would be easy enough to lay all the blame for my absence from this website on this personal crisis–but that would hardly be the whole truth.

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Why I’m a Buddhist, and why it matters

When I was 29 years old and finishing psychiatry residency, I was dumped by a young lady I’d been dating for a while. Not somebody I was seriously involved with, because in that callous age investing myself in a relationship was inconceivable. But my ego was bruised and my self-serving worldview rocked, so in a petulant fit of pique I changed clothes and went for a run. It’s a wonder that such a shallow moment could ever turn deep, but my spiritual journey was just about to begin. As I frantically ran around the block, my endorphins mingling with vain tears, these words came into my mind as if from above: “All it requires is to have faith in yourself, itself, to find happiness in any situation.” Continue reading

Bath salts: Another shitty drug having its day

Do you know what America’s “number one” drug problem was in 1978, according to both People magazine and Mike Wallace of 60 Minutes? No, not cocaine–which would have been factually correct–but phencyclidine, popularly known as PCP, angel dust, or “peep” in its heyday.  Back then the nation was horrified by “peepheads” smoking PCP-dusted marijuana, then going batshit crazy in a way that mere acid freaks rarely did. But by the time that these cultural watchdogs had alerted us to this alleged epidemic, it was already in decline. Because of a government crackdown? Nope, because the word had gotten out among potential users–PCP was a shit drug. Continue reading

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