According to psychologist Michael Brickey, author of Defying Aging and many other relationship experts, playful bantering or gentle flirting with someone outside of your marriage is harmless if proper boundaries remain intact. Those boundaries differ with each relationship, of course. What would be considered a violation in one marriage might be perfectly acceptable for another couple. Difference of opinions even occur within a marriage.

For example, I know a woman who recently asked her husband to either give her his Facebook password or close out his account after she found an email that he had sent to a former classmate that she found to be rather suggestive. He disagreed and thought it was perfectly appropriate.

Social media sites and online interaction are pushing this issue to dinner tables across the country — much more so than in the past. Katherine Hertlein, a licensed marriage and family therapist interviewed by Discovery News, explains, “You don’t actually recognize that you’re growing closer to someone on the Internet because it just looks like you’re having a conversation, and that’s why I think it could be really seductive in some ways.”

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is widely known as the bible of psychiatry and psychology.

But not many people know how this powerful and influential book came to be. Here’s a brief look at the DSM’s evolution and where we are today.

The Need for Classification

The origins of the DSM date back to 1840 — when the government wanted to collect data on mental illness. The term “idiocy/insanity” appeared in that year’s census.

Forty years later, the census expanded to feature these seven categories: “mania, melancholia, monomania, paresis, dementia, dipsomania and epilepsy.”

But there was still a need to gather uniform stats across mental hospitals. In 1917, the Bureau of the Census embraced a publication called the Statistical Manual for the Use of Institutions for the Insane. It was created by the Committee on Statistics of the American Medico-Psychological Association (now the American Psychiatric Association) and the National Commission on Mental Hygiene. The committees separated mental illness into 22 groups. The manual went through 10 editions until 1942.

Dr. Marsha Linehan, long best known for her ground-breaking work with a new form of psychotherapy called dialectical behavior therapy (DBT), has let out her own personal secret — she has suffered from borderline personality disorder. In order to help reduce the prejudice surrounding this particular disorder — people labeled as borderline often are seen as attention-getting and always in crisis — Dr. Linehan told her story in public for the first time last week before an audience of friends, family and doctors at the Institute of Living, the Hartford clinic where she was first treated for extreme social withdrawal at age 17, according to The New York Times.

At 17 in 1961, Linehan detailed how when she came to the clinic, she attacked herself habitually, cut her arms legs and stomach, and burner her wrists with cigarettes. She was kept in a seclusion room in the clinic because of never-ending urge to cut herself and to die.

Since borderline personality disorder was not discovered yet, she was diagnosed with schizophrenia and medicated heavily with Thorazine and Librium, as well as strapped down for forced electroconvulsive therapy (ECT). Nothing worked.

So how did she overcome this tragic beginning?

I had about 10 people forward me the New York Times article on the dwindling number of men going into counseling professions. Most of them know that male psychology is an area of special interest to me, and I’m also one of the only male therapists that they know. It has been interesting for me to learn that some controversy has emerged from the article, and the rationale for there being cause for alarm.

The article essentially made the case that if fewer men go into counseling professions, then fewer men may want to attend because they feel more comfortable talking about certain topics with other men. Dr. Grohol wrote a fabulous piece on this blog yesterday making the counter-point that there is no research evidence to support that view. While I also understand this to be true, I still have some concerns about the trend.

Imagine that your 16-year-old daughter has been bullied mercilessly in school, but hasn’t talked to you about it, or spoken about her suicidal impulses. One day, she is brought by ambulance to your local hospital emergency room, having made superficial cuts on her arms while in school. The emergency room physician tries to call you at work, but your cell phone isn’t picking up. The doctor begins her evaluation of your daughter, including an assessment of all relevant risk factors for suicide. Now imagine that the doctor believes she is forbidden by law from asking your daughter whether there are guns in your home — despite the fact that firearms in the home markedly increase the risk of gun-related suicide.1

You needn’t use much imagination. In Florida, Gov. Rick Scott is expected to sign a bill (SB-432) that will prohibit doctors from asking patients if they own guns, except when “…the information is relevant to the patient’s medical care or safety or the safety of others…”

The Florida bill was written with the help of — no surprise here — the National Rifle Association, which insists that this legislation is designed to prevent doctors from intruding on a patient’s privacy; “harassing” gun owners; and interfering with the patient’s second amendment “right to bear arms.” Similar bills are being considered in North Carolina and Alabama.

Today is the American Psychological Association’s “Blog Party” in recognition of May being mental health month. The marketing effort behind designating a specific month a time to recognize and help increase awareness of a certain disease, disorder or condition is intended to help people learn more about various medical and mental health concerns.

But a few weeks ago, physician H. Gilbert Welch wrote an op-ed in the LA Times that questioned whether the pendulum has swung too far the other way. Have we become a nation of people who will get diagnosed for all sorts of sub-clinical problems at the drop of a hat?

Indeed, I think there is a very real danger of that becoming the case. And nowhere is that more likely than in mental health.

Many companies sponsor things, and in the world of mental health and psychiatry, those companies tend to be pharmaceutical. Sponsorships help promote a company’s brand (and, indirectly, the products they sell). Since I believe — like most mental health professionals — that most people benefit from a combination of both medications and psychotherapy in the treatment of serious mental disorders, I see the value of many pharmaceutical companies’ products.

However, as we putter along in this age of the Internet, I’ve seen a disturbing trend toward blurring the line between editorial content and advertising.

And now I see, thanks to a blog entry this week by Dr. Danny Carlat, that this trend is being promulgated by one of the very organizations responsible for overseeing and accrediting continuing medical education, the Accreditation Council for Continuing Medical Education (ACCME).

May is Mental Health Month (if you hadn’t heard), and in keeping with that theme, it’s good to check in to see where mental health resides in various places in society.

One of those places is in our schools. Schools can be a helpful frontline in the identification — through screening programs — of at-risk children and teens who may get a mental disorder. In the past decade, schools have also become a necessary component of ensuring students who need mental health treatment have access to something that can help.

But University of Missouri researchers caution that when it comes to mental health programs in schools, one size does not fit all. Just trying to implement research-based solutions without truly understanding what the problem is in a particular school or school district is unlikely to help.

One of the common misconceptions about psychological testing is that even the so-called objective psychological tests (usually done on a computer or paper-and-pencil tests) tap into a single “truth” about the person. And that there is very little subjectivity in such tests.

In fact, one’s approach to taking a psychological test has a big impact on the test’s results — and the interpretations of those results by a trained psychologist.

The problem is that psychologists — and worse, the legal system — uses these tests as not only an indicator of where a person is in their life right now, but as a predictor of their future potential. If something as simple as one’s motivation can have a significant impact on one of these scores, what does that mean for the predictive power of these tests?

A fifteen-minute med check, a ‘scrip for some Prozac, and you’re outta here, buddy!

You got other problems? Talk to your therapist!

If the front-page article in the March 6 New York Times1 can be believed — and who wouldn’t believe America’s “Paper of Record”? — this is essentially what the practice of American psychiatry has become. But how accurate was the Times’ portrait of outpatient psychiatry? How grounded was it in the best available research? And given the roughly 30,000 psychiatrists in the U.S., how clear a picture can we get by peering through the eyes of one beleaguered practitioner who believes that psychotherapy is no longer “economically viable”?

As an occasional contributor to the Times who has great respect for its journalistic integrity, I’m sorry to say that this story was a disservice both to the Times readership, and to the profession of psychiatry. Although the article may have been a well-intended expose of malign insurance company practices, it amounted to a jaundiced caricature of psychiatric care — accurate in some respects, but distorted in many others. Furthermore, by disparaging the role of psychiatric medications, the Times article reinforced the “mind-body” split that has bedeviled psychiatry for the past 50 years, as Tanya Luhrmann showed in her classic study, Of Two Minds: The Growing Disorder in American Psychiatry.

But before critiquing the Times article, let’s own up to some real problems associated with current psychiatric practice.

This story caught my eye only because of its headline, Psychologists seek authority to prescribe psychotropic medications. Really? I thought… I never heard that before.

Oh, wait a minute, I have. Because the last time I checked, psychologists have been seeking prescription privileges for something like 16 or 17 years, maybe longer. In all of that time, they’ve only gained them in two states.

Was another state joining New Mexico and Louisiana? Was there a renewed push for this service because of a sudden demand for prescriptions from those who have a mental illness?

In other words, for this new article that appeared in the Washington Post (but was actually written by the Kaiser Family Foundation, a healthcare policy organization) — what’s newsworthy about this story?

After reading through the story twice, I couldn’t find a single thing.

Should you be able to review your psychotherapist on Yelp?

That’s the question psychologist Keely Kolmes asks in The New York Times the other day, and the answer is — yes, but.

There’s certainly nothing wrong with the idea behind having public reviews of health care professionals, including psychologists and therapists. But as Dr. Kolmes notes, what makes sense for a housekeeper, plumber or restaurant review becomes a bit difficult when dealing with confidential health information — which includes a person’s relationship with a therapist.

A psychotherapy relationship is a very unique relationship. A person can have a bad therapy experience with a perfectly good therapist, and vice-a-versa. The current set of review websites, like Yelp, really aren’t very good when it comes to understanding the unique and complex relationship people have with their therapist.