>> Someone left an article for me: “How ‘Objective’ are Psychiatric Diagnoses?” The photocopied pages were cool to the touch and a yellow Post-it note, with nothing written on it, was stuck on page three. I was not entirely sure that the article was meant for me, though I suspected this was the case: I recently delivered a presentation at a conference and discussed the problems with validity and reliability in psychiatric diagnosis. There was some mild protesting.

The article (available in its entirety in the above link—it’s short) argues that there exists reliability in psychiatric diagnosis (though the question of validity remains unanswered) that is comparable to or perhaps exceeds medical diagnosis. The author concedes that he did not conduct a thorough review of the literature (psychiatric or otherwise), but, to be fair, what information he does present did capture my attention (his examples include cancer and arthritis). The anonymous donor of this article must have anticipated this.

>> I received a copy of New York Presbyterian Psychiatry in the mail today. I find this curious for three reasons:

1. I didn’t even know New York Presbyterian Hospital produced a psychiatric newsletter.
2. I don’t live in New York City. I live in Seattle. How does the hospital know anything about me? (To be clear, New York Presbyterian Hospital is not affiliated with a consult-liaison psychiatry fellowship, though the two institutions affiliated with that hospital do offer fellowships. I shan’t write anything further.)
3. Why would they start sending me this newsletter now?

Omen? (!)

The cover story of this newsletter is “Borderline Personality Disorder: Researchers Advocate Transference-Focused Therapy”.

Ah ha, I mused. New York City wants to compete with Seattle.

Dialectical behavior therapy (a behavioral intervention for borderline personality disorder) was developed in Seattle. Transference-focused therapy (a psychodynamic intervention) was developed in New York City. It’s not just a transcontinental clash (okay, maybe “clash” is too strong of a word); it’s also a theoretical debate. Let the behaviorists and analysts have at it!

This is interesting. You betcha I’ll be presenting the paper on transference-focused therapy for borderline personality disorder at the next journal club—it’s amusing (…) to point out and poke fun at the potential polarization, particularly since dialectical behavior therapy is all about dialectics!

>> There is a proposal in to fund mental health services in King County. The plan suggests a 0.1% increase in sales tax to fund services to decrease incarceration, increase resources for youth, and provide more assistance for the mentally ill who are homeless.

As someone who is currently working with homeless, chronically mentally ill individuals who frequently end up in jail (usually for criminal trespass, failure to appear, and the occasional assault 4) in Seattle, I can (grossly) see how the extra funding could be extraordinarily helpful. However, I can also see how voters would rather spend the money elsewhere: It’s more bureaucracy and more money doesn’t necessarily equate to positive change. (Just how much of the money will translate into concrete services that the chronically mentally ill can access? etc.) For those who endorse the opinion that people who are homeless and indigent “deserve” that fate due to character flaws (laziness, substance use, stupidity, etc.), it certainly doesn’t make sense to give earned riches to the poor. (”Robin Hood was totally overrated!”)

Meritocracy doesn’t apply to everyone, despite the fact that it is ingrained in American culture.

There are 29 pages in the proposal. I need to start reading.