Traditionally, most hospitals have separated out the psychiatric record from a patient’s medical record. This was done historically because of the stigma and discrimination associated with psychiatric concerns — and the serious lack of training in medical school for physicians to understand such information in proper context.

As hospitals move to electronic records, the default behavior has been to simply keep things as they are — so no more processes than necessary have to change at the same time. This means keeping the psychiatric information in the electronic record segregated from a patient’s medical information.

But in an intriguing new study just published — on a very small cohort — researchers found that where hospitals allowed any properly authorized medical staffer to access the patient’s psychiatric information in the electronic health record (EHR), hospital readmissions went down.

“I hate you people for leaving me out of so many fun things.”

Those words were not written by Adam Lanza, but another school shooter, Eric Harris, whose life was also wrought with themes of alienation and social awkwardness. Eric Harris, a Columbine shooter, compiled journal entries that pulsate with narcissistic rage and reveal a tendency to rely upon the psychological strategy of splitting: separating the world into black or white, weak or strong, good or bad, me or them.

Splitting can be seen in certain personality disorders and might also be used by some to justify bullying someone, starting a militia or cult, deciding to home-school a child, maintaining a survivalist mentality or even getting a divorce. Extreme cases of splitting can even contribute to rationalizing suicide or murder.

Have you told your doctor about the other medications or drugs you regularly take? If you’re on an antidepressant, you probably should.

If you’re taking non-steroidal anti-inflammatory drugs (NSAIDs), you may be less likely to experience the beneficial effects of the most commonly prescribed classes of antidepressants, SSRIs (such as Paxil, Zoloft and Prozac).

NSAIDs include ibuprofin (such as Advil, Motrin, and Midol), naproxen sodium (such as Aleve) and good ole aspirin.

According to an article appearing in the recently published The Carlat Psychiatry Report, that was the surprising conclusion of a paper published last year (Warnerschmidt Jl et al, Proc Natl Acad Sci USA 2011;108:9262–9267), and a newly released report reaches a similar conclusion.

All too often, I find myself knee-deep in discussions about language. “What do we call X?” “Wouldn’t it be better to be more ‘inclusive’ and use this other word instead?”

Nowhere is that more evident when it comes to the world of mental illness.

Finding that the word “patient” is too medically oriented, Carl Rogers — 50 or so years ago — suggested a more agnostic term, “client” (such as a lawyer or accountant might have a client). And while I agree client is a more agnostic term, Rogers unfortunately and unintentionally opened up an entire can of worms.

One that haunts us to this day and interferes with our basic ability to communicate when it comes to mental health concerns.

My first introduction to the Diagnostic Statistical Manual (DSM), published by the American Psychiatric Association (APA), was standing in the kitchen of my parents’ home and witnessing my father in full rant.

My dad was a psychiatrist/ psychoanalyst of the old school. Which is to say he was brilliant, but also a man of his particular age. Which is to further say his fury was directed at the APA for taking homosexuality as a diagnosable mental illness out of the manual. It was 1973.

Hardly aware of what he was so upset about, I did hear him dramatically declare that he was withdrawing his membership in the APA. My dad loved being a psychoanalyst and he loved being a physician but he wasn’t that crazy (you should forgive the word) about being a psychiatrist. His prescription pad gathered dust as he focused on talk therapy. So his threat to quit the APA wasn’t idle. But it wasn’t like he was giving up his beloved couch.

Yesterday, the board of trustees of the American Psychiatric Association (APA) approved a set of updates, revisions and changes to the reference manual used to diagnose mental disorders. The revision of the manual, called the Diagnostic and Statistical Manual of Mental Disorders and abbreviated as the DSM, is the first significant update in nearly two decades.

Disorders that will be in the new DSM-5 — but only in Section 3, a category of disorders needing further research — include: Attenuated psychosis syndrome, Internet use gaming disorder, Non-suicidal self-injury, and Suicidal behavioral disorder. Section 3 disorders generally won’t be reimbursed by insurance companies for treatment, since they are still undergoing research and revision to their criteria.

So here’s a list of the major updates…

As writer Pearl Buck said, “If you want to understand today, you have to search yesterday.”

Tracking how psychology has evolved throughout the centuries helps us better understand psychology today. That’s why every month we dig around to find the most interesting articles and videos on the renowned — and sometimes notorious — people and places that have led to where we are right now.

In last month’s roundup, we talked about psychology’s controversial figures and tall tales. This month is no exception. There are links about infamous psychologists John Watson and John Philippe Rushton. There are also links to psychology’s beginnings with early concepts of mental disease and the functionalist school.

While attending the 28th Annual Rosalynn Carter Symposium on Mental Health Policy at The Carter Center last week, it occurred to me that mental health professionals are some of the worst when it comes to discriminating against people with mental illness.

They do this in insidious and subtle ways, suggesting a patient can’t do the things others without mental illness can do. Like hold down a job, get into independent housing, interact in social situations or even just go back to school and get a degree.

They also do this in more direct ways, by suggesting to their patients applying for a job or going back to school that, “If they don’t ask about mental illness, don’t volunteer that information.” Why not?

Why are mental health professionals helping to contribute to discrimination and stigma about mental illness by making these suggestions?

I have to wonder how helpful it truly is to be playing armchair psychiatrist, when you’ve never personally interviewed the person under discussion. Imagine all the things we could just hypothesize about any celebrity, based only upon a snippet of their public behavior (a snippet we carefully choose, of course).

There’s a profession that does something like this. They’re called publishers, and they publish tripe such as “Us Weekly” and “Star” magazine. They take a piece of gossip and write an entire story based upon nothing more than speculation, imagination and hype.

So I found it more than a little disappointing (but perhaps not surprising) to find a representative of the mental health profession, Dr. Keith Ablow, on Fox News Sunday night doing just that. He spoke during a “Medical A-Team” segment where a group of doctors talked about the vice-presidential debate.

Should a psychiatrist be discussing differential diagnoses of the Vice President of the United States — especially if they’ve never even met the man?

I very much appreciate Dr. Grohol’s taking the time to comment on my essay about physician-assisted suicide. I have great respect for his wisdom, judgment and fairness, and I recognize that reasonable people will disagree on this hotly-contested and complex issue.

I certainly don’t pretend to have reached any final “truth” in the matter of physician-assisted suicide (PAS). At the same time, I believe that Dr. Grohol’s conclusions (1) rest on several misapprehensions regarding my own position; the ethical responsibilities of physicians; and the relevant medical facts pertaining to terminally ill patients.

Dr. Grohol argues that the debate is really “…about patient empowerment, human dignity and choice.”

I fully agree with Dr. Grohol that the patient’s autonomy is of great importance; indeed, autonomy is considered one of the four cardinal principles of medical ethics, along with benevolence, nonmalfeasance and justice (2).

But sometimes, medical ethics must set limits on a patient’s autonomous requests, even in the context of an understandable choice on the patient’s part. Thus, a patient may feel completely justified and “empowered” in requesting that the dose of her pain medication be doubled, even though that would be extremely dangerous to her health.

A common reason people don’t take their medication is because they simply forget. For instance, taking medication can become so reflexive that you’re unsure whether you took your pill or not, said Ari Tuckman, PsyD, a clinical psychologist and author of Understand Your Brain, Get More Done: The ADHD Executive Functions Workbook. He compared it to other autopilot activities, like driving to work.

You also might confuse thinking about taking your medication with actually doing it, he said. “This is especially likely with repeated activities where we have a lot of memories of the task [blurring] together,” he said.

With many medications there are also no immediate consequences. So you might not realize you missed a dose. It may take a few days or weeks to notice a big difference, said Kelli Hyland, M.D., a psychiatrist in outpatient private practice in Salt Lake City, Utah.

Thomas Szasz, M.D. died on September 8, 2012 at the ripe old age of 92. He was a pioneer in the field of making us rethink what we mean when we say someone is “mentally ill.” Is it really a purely physical disease, or is it part physical, part social construct?

And if it’s partly a social construct (and, to be honest, it is), it must be subjective. We’ve all simply agreed that this set of symptoms = mental illness. Keep in mind that his theories were based with our knowledge of mental illness in the 1950s and 1960s — a time when our understanding of mental illness was truly in its infancy. At that time, mental disorders truly were quite arbitrarily defined.

While many associate Szasz with the anti-psychiatry movement, that’s a label he never was comfortable with. It also over-simplifies his complex and nuanced views about mental illness as one of the most vocal critics of psychiatry.