email page print pageAll Topic Reviews
Health Care in America The Happiness of Burnout"Guns Don't Kill People, People Kill People""How Come Boys Get to Keep Their Noses?"17 Lies That Are Holding You Back20 Jazz Funk Greats50 Popular Beliefs That People Think Are TrueA Brief History of the SmileA Child of One's OwnA Citizen Legislature/A People's ParliamentA Clinician's Guide to Legal Issues in PsychotherapyA Colorful History of Popular DelusionsA Cultural History of Modern Science in ChinaA Cursing Brain?A History of Intelligence and "Intellectual Disability"A History of MarriageA History of PsychiatryA Little F'd UpA Loving Approach to Dementia CareA Man's Guide to Healthy AgingA Mind ApartA Mind So RareA Natural History of RapeA Natural History of VisionA Red Heart of MemoriesA Short History of MedicineA Student's Guide to the History And Philosophy of Yoga A Tear is an Intellectual ThingA Therapist's Guide to Understanding Common Medical ProblemsA Universe of ConsciousnessA User's Guide to the BrainA World Full of GodsABC of Eating DisordersABCs to Positive LivingAbnormal Psychology in ContextAbout FaceAccessible Yoga for Every Body DVDActs of ConscienceAdvances in Culture and PsychologyAfter HarmAfter the Ecstasy, the LaundryAfter the Globe, Before the WorldAgainst the MachineAging Our WayAIDS & People with Severe Mental IllnessAkhenatenAl-JununAlgernon, Charlie and IAll About LoveAllergy ReliefAlone TogetherAlpha GirlsAltered EgosAltered StatesAlways On CallAm I Making Myself Clear?Am I Okay?AM/PM YogaAmerica in the FortiesAmerican Science Fiction Film and TelevisionAmong the Great ApesAn American ObsessionAn Anthropologist on MarsAn Illustrated Book of Bad ArgumentsAn Odd Kind of FameAnatomy of an EpidemicAnger, Madness, and the DaimonicAnimal ArchitectsAnimal MindsAnimals in TranslationAnother CountryAntimatterAre the Rich Necessary? Updated and Expanded EditionArt and PoliticsArtemis FowlAs Nature Made HimAsylumAsylum on the HillAsylum to ActionAt Liberty to DieAtonement and ForgivenessAttention Deficit DisorderAttitudeAuthentic HappinessBe Very AfraidBeautiful MindsBeauty's NothingBeckett and AnimalsBecoming a DoctorBeing VirtualBelle and Sebastian's If You're Feeling SinisterBest of the Brain from Scientific AmericanBetrayal TraumaBetter Sex Through YogaBeyond AIBeyond GreekBeyond HealthBeyond ReasonBeyond ToleranceBibliotherapyBipolar DisorderBlack Man in a White CoatBlack MassBlind SpotsBlinkBlood and GutsBodies out of BoundsBody Piercing Saved My LifeBorn Standing UpBrain LongevityBrain-Based Teaching for All SubjectsBrainchildrenBrainwashingBread Upon the WatersBreaking Murphy's LawBreaking WomenBreathingBrian Eno's Another Green WorldBrief EncountersBritain on the CouchBrothelBuddhism and ScienceBuilding Healthy MindsBullspottingBullying PreventionBurn UnitBuzzC StreetCalling Our Spirits HomeCamp ZCancer on $5 a Day* *(chemo not included)Cato's TearsCaughtChained to the DeskChickenizing Farms and FoodChild Slaves in the Modern WorldChildren's Learning in a Digital WorldChina on the MindChoices and ConflictChoosing CivilityChronic Fatigue Syndrome (The Facts)Classical Pilates Technique DVDCleopatraClinical Psychopharmacology Made Ridiculously SimpleClosing the AsylumsCognition, Creativity, and BehaviorCognitive Neuroscience of EmotionCollege Inc.Coming of Age in AmericaComing of Age in Ancient GreeceConceptual BlockbustingConcrete ReveriesConducting Insanity EvaluationsConfronting Postmaternal ThinkingConnected, or What It Means to Live in the Network SocietyConsciousnessConsider the LobsterConsuming InnocenceContagiousControlConversations About Psychology and Sexual OrientationCool WomenCorpora in Language Acquisition ResearchCorrect EnglishCorrupted CultureCount Us InCovered in InkCreative AngerCreative Core AbsCreative ThinkeringCreative Writing In Health And Social CareCreatures of AccidentCrime and Punishment in AmericaCritical ConditionCritical Perspectives in Public HealthCritical Psychology: An IntroductionCross-Cultural Topics in PsychologyCrossingCrossing the Unknown SeaCruddyCultural Healing and Belief SystemsCulture and Subjective Well-BeingCustomers and Patrons of the Mad-TradeCyber BullyingCyber-Safe Kids, Cyber-Savvy TeensDance the Chakras Yoga WorkoutDancing After HoursDangerous EmotionsDarwin's Dangerous IdeaDarwin's LegacyDeaf Identities in the MakingDeath in the AirDebunked!DeceptionDecoding DarknessDeep GossipDefenders of the TruthDefining Moments in ScienceDefying DementiaDeinstitutionalization And People With Intellectual DisabilitiesDematerializingDementiaDementia Caregivers Share Their StoriesDemons of the Body and MindDemons of the Modern WorldDepression In Later LifeDirty DetailsDiscourse of Twitter and Social MediaDistractedDivine MadnessDMT and the Soul of ProphecyDo-It-Yourself Eye Movement Techniques for Emotional HealingDoes Science Need a Global Language?Doing GoodDon't Believe Everything You ThinkDon't Get Too ComfortableDr. Andrew Weil's Guide to Optimum HealthDr. Andrew Weil's Mindbody ToolkitDreaming and Other Involuntary MentationDSM-IV SourcebookDSM-IV-TR Case StudiesDuplicityDutiful DaughtersDying for TimeEarthly Bodies, Magical SelvesEastern Body, Western MindEating AnimalsEccentricsEcological MedicineEducating People to Be Emotionally IntelligentEinstein and OppenheimerElectroshockElliott Smith and the Big NothingEmergence and EmbodimentEmergencies in Mental Health PracticeEmotionEmotional Intelligence at WorkEmotions RevealedEncyclopedia of Asylum Therapeutics, 1750-1950sEntwined LivesErotic PassionsEssentials of Cas AssessmentEssentials of Wais-III AssessmentEthics for the New MillenniumEvamarie Pilipuf's Yoga Express DVDEvery Day Yoga for Every Body DVDEveryday GreensEveryday IrrationalityEveryday SimplicityEverything Is MiscellaneousEvolutionEvolution and Human BehaviorEvolution in MindEvolution's RainbowExploring the Edge Realms of ConsciousnessExuberanceEyes of SophiaFalling for ScienceFalse-Memory Creation in Children and AdultsFamilyFamily Desk Reference to Psychology Fashion and Its Social AgendasFashion, Desire And AnxietyFast, Fresh & GreenFat and FuriousFear and Other Uninvited GuestsFearless ConfessionsFeminist Philosophy And Science FictionFinal ExamFine LinesFixing My GazeFlesh of My FleshFlesh WoundsFlirting With DangerFlow and YinFlying ColorsFocusFood for Thought:Food, Medicine, and the Quest for Good HealthFool Me TwiceFreedom, Fame, Lying, and BetrayalFridaFrom Certainty to UncertaintyFrom Joy Division to New OrderFull Frontal Feminism: A Young Woman's Guide to Why Feminism MattersFull Steam Ahead!Galileo Goes to Jail and Other Myths about Science and ReligionGang of Four's EntertainmentGender and Its Effects on PsychopathologyGender and Mental HealthGeneration DigitalGenetics of Mental DisordersGeniusGenomeGetting a Good Night's SleepGetting Inside Your HeadGetting WastedGilded CityGirl in the CurlGirlfightingGirls Gone MildGirls on the VergeGod and the MultiverseGood FortuneGood KarmaGood MedicineGood WorkGracefully InsaneGrassroots SpiritualityGreat Psychologists and Their TimeGulpHabeas CorpusHalf a Brain Is EnoughHandbook of AttachmentHappinessHappinessHappiness Is.Hate Crimes in CyberspaceHealingHealing SpacesHealth And the MediaHealth OnlineHearing the Person With DementiaHeavier than HeavenHello from Heaven!HelmholtzHelvetica: A documentary filmHemalayaa's Yoga for Young Bodies DVDHemingway's Second WarHerbs for the MindHere Is New YorkHeroes, Rogues, and LoversHeterophobiaHidden MindsHistory of ShitHistory of SuicideHoly Sh*tHoly WarHooked!Hot Body Cool Mind - Level 1Hot Body Cool Mind: Waking Energy Hot Chocolate for the Mystical LoverHot SpotsHotHouseHouse and PsychologyHow Children Learn the Meanings of WordsHow Doctors ThinkHow Emotions WorkHow Our Lives Become StoriesHow Proust Can Change Your LifeHow Science WorksHow to Build a Robot ArmyHow to Cook Everything VegetarianHow to Grow OldHow to Handle a Hard-To-Handle KidHow We AgeHow We Are Changed by WarHumankindHungerHysteria Complicated by EcstasyI Contain MultitudesI Know Who You Are and I Saw What You Did: Social Networks and the Death of PrivacyI of the VortexI Only Say This Because I Love YouI, Little AsylumIdiot AmericaIf Men Could TalkIgnoranceIllness and ImageImagining NumbersImprove Your Writing With NLPIn Bed with MadnessIn Defense of FoodIn Praise of ScienceIn Pursuit of HappinessIn Search of FatimaIn the Line of DutyIn the Shadows of the NetIn Therapy We TrustIndivisible by TwoInsight Yoga with Sarah PowersIntegrative MedicineIntensive CareIntroduction to Ashtanga Yoga DVDIntroduction to Qi YogaIntroduction to Yoga DVDInvented KnowledgeInvestigating Digital CrimeIrrationalityIs Shame Necessary?It's Up to YouJanis Saffell Beverly Hills YogaJudo with WordsKanye West's My Beautiful Dark Twisted FantasyKids OnlineKilling MonstersKinds of MindsKissing DoorknobsKnowing the Nature of FearKnowledge MonopoliesKundalini Yoga for Beginners & BeyondLandscapes in My MindLaw, Mind and BrainLearning About School ViolenceLearning, Teaching and Education Research in the 21st CenturyLessons Learned on My Way HomeLicentious GothamLies! Lies! Lies!Life CoachingLife MakeoversLimboListening in the Silence, Seeing in the DarkListening to PainListening to the WorldLittle PeopleLittle Red Riding Hood UncloakedLiving DeeplyLiving Well with Pain and IllnessLiving with ArthritisLiving with SchizophreniaLiving, Thinking, LookingLoneliness as a Way of LifeLong Shadow of Small GhostsLosing My MindLove and Sex with RobotsLove Your Body, Love Your LifeLove, Sex & TragedyLust in TranslationMad Mary LambMade in AmericaMadhur Jaffrey's World VegetarianMadnessMadness in CivilizationMaidentripMake It CountMake It Fast, Cook It SlowMaking Babies the Hard WayMaking Dying IllegalMaking SpaceMaking the Big LeapMaking Your Mind MatterMale Female EmailMalefemaleMan As The PrayerManaged Care ContractingMandated Reporting of Suspected Child AbuseManic Depression and CreativityManlinessManning UpMapping the MindMarriage ConfidentialMary Pope Osborne's Tales from the OdysseyMaster PassionsMasters of the MindMatters of SubstanceMean GenesMedia ArgumentationMedia in the Digital AgeMediating MadnessMedical AnthropologyMedicine and Health Care in Early ChristianityMedicine and Philosophy in Classical AntiquityMedieval Writings on Female SpiritualityMemoires 1995Memory, Brain, and BeliefMental Health and Social SpaceMental Health MattersMental Illness in Popular MediaMerchants of DoubtMild Cognitive Impairment and Early Alzheimer's DiseaseMiles to Go for FreedomMillennium GirlsMind in Everyday Life and Cognitive ScienceMind WarsMind, Matter and Quantum MechanicsMindstormsMisconceptionsMistakes Were Made (But Not by Me)Mollie Katzen's RecipesMom's OK, She Just ForgetsMonsters, Demons and PsychopathsMoody BitchesMoral PanicsMore Than MedicineMortificationMothers Who Kill Their ChildrenMusicophiliaMy Bloody Valentine's LovelessMy Life Among the Serial KillersMy Misspent YouthMy Stroke of InsightNakedNaked CityNarratives in PsychiatryNations Have the Right to KillNatureNear Death ExperienceNeurons and NetworksNeuroscience in Science Fiction FilmsNew Versions of VictimsNew YorkNew York September 11Not by DesignNot Your Mother's LifeNothing to HideNurembergNymphomaniaOath BetrayedObesityObjects of Our DesireObliquityOdd CouplesOf Spirits & MadnessOf Two MindsOld AgeOn BlindnessOn Fact and FraudOn the BrinkOn the Origin of StoriesOne Nation Under TherapyOpening to Love 365 Days a YearOptimizing Teaching and LearningOtherhoodOut of the DustOutliersOutsider ArtOver My HeadOxford Guide to the MindPainParanoia of Everyday LifeParents Do Make a DifferenceParty GirlPassingPassionate VegetarianPathways through PainPeople Like OurselvesPerceptual NeurosciencePersons and ThingsPestos, Tapenades, and SpreadsPhilosophy of MindPhotography and LiteraturePilates for MenPink ThinkPlanning for UncertaintyPoets on ProzacPostcards from the Brain MuseumPosthumanismPotatoes Not ProzacPower HerbsPower Yoga for HappinessPoxPractical ClassicsPractical Plans for Difficult Conversations in MedicinePracticing Feminist Ethics in PsychologyPrader-Willi SyndromePredictably IrrationalPretty in PunkPretty Is What ChangesPreventing Misbehavior in ChildrenPrime Ministers of CanadaPrint Literacy DevelopmentPrison MadnessPrivate Life in New Kingdom EgyptProblems in MindProtecting the GiftProust and the SquidPrudePsychiatryPsychiatry in the New MilleniumPsychiatrylandPsychologyPsychology and the MediaPsychology for ScreenwritersPsychotherapy and ConfidentialityPublic Health LawPunishment in Popular CulturePure Yoga Pilates with Kerry BestwickQuantum ArchetypesQuantum LeapsR.I.P.Race in Contemporary MedicineRacial ParanoiaRaising a Self-StarterRaising AmericaReady for AnythingReady or NotReady or Not, Here Life ComesReal SexReckoning With HomelessnessReclaiming Our ChildrenReclaiming Soul in Health CareRed Lotus YogaReligion ExplainedRemaking a WorldRepublic.com 2.0Rethinking CommodificationRethinking Middle YearsReviving OpheliaReviving the LeftRewarding Specialties for Mental Health CliniciansRick SingsRights, Risk and Restraint-Free Care of Older PeopleSabbathSame DifferenceSamuel BeckettSatisfactionSavedScared SickScienceScience and NonbeliefScience in the MarketplaceScience TalkScience WarsScience, Consciousness and Ultimate RealitySecond OpinionsSeeds of HopeSelected Ambient Works Volume IISelf Hypnosis for Cosmic ConsciousnessSelf-Help NationSelf-Help, Inc.Selling the Fountain of YouthSells like Teen SpiritSerious ShoppingSeven Challenges To Change Your Life DVDSex, Mom, and GodSex, Time and PowerSexing the BodySexual Orientation and School PolicySexy FeminismShadow, Self, SpiritShop Class as SoulcraftShrink RapSick to Death and Not Going to Take It AnymoreSimulation and Its DiscontentsSinfully VeganSister CitizenSleeping With Extra-TerrestrialsSlut!Snake Oil ScienceSnoopSo Brilliantly CleverSocial RepresentationsSolar Flow Yoga DVDSold on LanguageSome Kind of GeniusSometimes Madness Is WisdomSorting Things OutSoul Made FleshSounds from the Bell JarSoupsSpace, Place and Mental HealthSpeaking Our MindsSpiritual CrisisSpontaneous HealingStates of MindStatus AnxietyStiffedStill HereStill LivesStrange BehaviorStrategies of Commitment and Other EssaysStrength, Grace, HealingStroke DiariesStumbling on HappinessSun SalutationsSuper Natural CookingSuperstitionSupersurvivorsSurgery JunkiesSwordfishtrombonesSylvia Plath ReadsTalk to HerTalking About RaceTalking Back to PsychiatryTalking Heads' Fear of MusicTalking ScienceTeach Yourself MeditationTeaching OnlineTeaching SexTeen LoveTeenageTextbook of Cultural PsychiatryThanks!The 101 Best Graphic NovelsThe Age of American UnreasonThe Alice Behind WonderlandThe American HotelThe American ParadoxThe American Psychiatric Publishing Textbook of Clinical PsychiatryThe Americanization of Social ScienceThe Anatomy of HopeThe Anatomy of MelancholyThe Angelica Home KitchenThe Antibiotic EraThe Ape and the Sushi MasterThe Architecture of MadnessThe Arctic IncidentThe Art of ChoosingThe Art of Exceptional LivingThe Bard on the BrainThe Barmaid's BrainThe Beginner's Guide to Healthy EatingThe Better to Eat You WithThe Biotech CenturyThe Birth of PleasureThe Birth of the PillThe Black DeathThe Blackwell Handbook of Organizational Learning and Knowledge ManagementThe Book of the PenisThe Brain That Changes ItselfThe Breathing FieldThe Bridge to HumanityThe Brooklyn Nobody KnowsThe Bully SocietyThe Cafe Brenda CookbookThe Call of the WeirdThe Cambridge Illustrated History of MedicineThe Case Against SugarThe Childless RevolutionThe Clitoral TruthThe Complete Guide to Herbal MedicinesThe Complete Vegetarian HandbookThe Consolations of PhilosophyThe Contemplative HeartThe Couch and the TreeThe Course of Gay and Lesbian LivesThe Creation of the Modern WorldThe Cult of PharmacologyThe Cultural Origins of Human CognitionThe Culture of FearThe Culture of PunishmentThe Da Vinci DogThe Dark Night of the SoulThe Deadly TruthThe Decency WarsThe Disobedience Of The Daughter Of The SunThe Dynamic NeuronThe Easy Yoga WorkbookThe Emotional BrainThe Emotional Journey of the Alzheimer's FamilyThe Employee Assistance Treatment PlannerThe End of MaterialismThe End of WarThe English and their HistoryThe Enigma of HealthThe Era of ChoiceThe Eternity CubeThe Event of LiteratureThe Evolving WorldThe f WordThe Fabulous ImaginationThe Faces of TerrorismThe Farm Colonies: Caring for New York City's Mentally Ill In Long Island's State HospitalsThe Fat Studies ReaderThe Fate of Early MemoriesThe Female ThingThe Final LeapThe Firmament of TimeThe Five Things We Cannot Change ...The ForgettingThe Game of TruthThe Get Healthy, Go Vegan CookbookThe Gift of FearThe Gold Leaf Lady and Other Parapsychological InvestigationsThe Good Enough ChildThe Great BetrayalThe Greatest Experiment Ever Performed on WomenThe HandThe Handbook of Disability StudiesThe Happiness HypothesisThe Healing Remedies SourcebookThe Health Psychology HandbookThe Healthy KitchenThe Heart of YogaThe Hedgehog's DilemmaThe Hero's JourneyThe History of Rhetoric and the Rhetoric of HistoryThe History of White PeopleThe Homework MythThe Hungry SoulThe Identity CodeThe Immortalization Commission:The Importance of Being LazyThe Indian VegetarianThe Insider's Guide to Mental Health Resources OnlineThe Insider's Guide to Mental Health Resources OnlineThe Insider's Guide to Mental Health Resources OnlineThe Insider's Guide to Mental Health Resources OnlineThe Intelligibility of NatureThe Interdisciplinary Science of ConsumptionThe Intuitive WriterThe Invisible PlagueThe Irreducible Needs of ChildrenThe Irritable Male SyndromeThe Jewel Tree of TibetThe Joy of MeditatingThe Language ImperativeThe Language Of YogaThe Language PoliceThe Language WarsThe Last PhysicianThe Last Self-Help Book You'll Ever NeedThe Law Is a White DogThe Lie DetectorsThe Little Book of Healthy TeasThe Little Book of HeartbreakThe Little Soy BookThe Little Yoga BookThe Lives and Loves of Daisy and Violet HiltonThe Lives of AnimalsThe Lolita EffectThe Lonely PatientThe Loss of Self: A Family Resource for the Care of Alzheimer's Disease and Related DisordersThe Lucifer EffectThe Lucifer PrincipleThe Madness of Adam and EveThe Madwoman in the AtticThe Magic of RealityThe Making of Dr. PhilThe Manual of EpictetusThe Marketplace of IdeasThe Mature MindThe Measure of Our DaysThe Meat Lover's Meatless CookbookThe Medical AdvisorThe Medicalization of SocietyThe Metaphysical ClubThe Mind's PastThe Misunderstood GeneThe MIT Encyclopedia of the Cognitive SciencesThe Monster WithinThe Mood CureThe Moral Intelligence of ChildrenThe Mystery of Mary RogersThe Myth of Freedom and the Way of MeditationThe New BrainThe New Cancer SurvivorsThe NineThe Nordic Theory of EverythingThe Norm ChroniclesThe Normal OneThe Omnivorous MindThe Orchid ThiefThe Origin and Evolution of CulturesThe Oxford Book of Modern Science WritingThe Pain AntidoteThe Paradox of ChoiceThe Paradox of SleepThe Paranoia SwitchThe Passion PlanThe Pastoral Counseling Treatment PlannerThe PDR Family Guide to Natural Medicines & Healing TherapiesThe Physics of ConsciousnessThe PlaceboThe Placebo Effect and HealthThe Playful BrainThe Pocket Life CoachThe Portfolio and the DiagramThe Power of FocusThe Power of Full EngagementThe Praeger Handbook of Learning and the BrainThe Private Life of the BrainThe Professor and the MadmanThe Psychoanalytic MysticThe Psychology of Religion and CopingThe Psychology Of The InternetThe Psychotherapy Documentation PrimerThe Quantum UniverseThe Quarter-Acre FarmThe Race for ConsciousnessThe Real Rules for GirlsThe Red DevilThe Republican BrainThe Richer SexThe Rise and Fall of Classical GreeceThe Rise of Mental Health NursingThe Roman Search for WisdomThe Root of All EvilThe Routledge Companion to Landscape StudiesThe Same Stuff as StarsThe Savage CityThe Science of Good and EvilThe Science of Optimism and HopeThe Scientist In The CribThe Seat of the SoulThe Second SelfThe Secret History of DreamingThe Secret Lives of GirlsThe Secret World of Doing NothingThe Seven Sins of MemoryThe ShakeressThe ShallowsThe Social Psychology of StigmaThe Sociology of PhilosophiesThe Sociopath Next DoorThe Soul Knows No BarsThe Spa DeckThe Spiritual Anatomy of EmotionThe Split MindThe Star ThrowerThe Story Is TrueThe Storytelling AnimalThe Strange Case of Hellish NellThe Symmetry of GodThe Talking CureThe Thing You Think You Cannot DoThe Three CulturesThe Three Failures of CreationismThe Toxic ConsumerThe Triumph of NarrativeThe True PathThe Truth About Chronic PainThe UndertakingThe Volitional BrainThe Wages of SinThe War Against BoysThe Way of StretchingThe Weblog HandbookThe Weight of the NationThe Why CaféThe Wild Ass’s SkinThe Will to Live and Other MysteriesThe Wisdom of PsychopathsThe Wisdom of Your DreamsThe Words We Live ByThe World of CaffeineThe Worldwide Practice of TortureThe Worst-Case Scenario Survival HandbookThe Wow ClimaxTheaters of MadnessTheatre and AnimalsTheories of Scientific MethodTherapeutic LandscapesTheraScribe 4.0Think CatThink SmartThinking for a ChangeThinking With AnimalsThrough Deaf EyesToo Big to FailTooning InTop ChefTortured SubjectsTotal AstangaTotal PilatesTotally WiredTowards a Science of Consciousness IIITrain Your Brain to Get RichTransforming MadnessTraumatic PastsTreatment and Rehabilitation of Severe Mental IllnessTreatment Kind and FairTribal ScienceTrick or TreatmentTrusting DoctorsTry to RememberTutoring as a Successful BusinessTwelve Examples of IllusionTwinsUnder the Medical GazeUnderstanding and Treating Violent Psychiatric PatientsUnderstanding Child MolestersUnderstanding FitnessUnforgettableUnholy MadnessUnscientific AmericaUnspeakable Acts, Ordinary PeopleUnto OthersUp From DragonsUrban Tourism and Urban ChangeUseful BodiesValues in ConflictVarieties of Anomalous ExperienceVegan ExpressVegetarian Turkish CookingVertigo VisionsVictorian Popularizers of ScienceViniyoga Therapy for the Low Back, Sacrum and HipsViolence Against WomenVoices Of Alzheimer'sVoices of CaregivingVoices of MadnessVoluntary SimplicityWaking Up to What You DoWalkingWalking a Literary LabyrinthWall: A World DividedWarWays of KnowingWays of KnowingWe Shall Be No MoreWe Shall Not Be MovedWe've Got BlogWellbeingWhat Emotions Really AreWhat I Learned in Medical SchoolWhat in the World Are Your Kids Doing Online?What Makes Us Think?What Nietzsche Really SaidWhat Our Children Teach UsWhat Science Offers the HumanitiesWhat Video Games Have to Teach Us About Learning and LiteracyWhat's Holding You Back? What's So Wrong with Being Absolutely RightWhen a Family Member Has DementiaWhen Experiments TravelWhen Good Thinking Goes BadWhen History Is a NightmareWhen Johnny and Jane Come Marching HomeWhen Mothers KillWhen Sex Goes to SchoolWhen Someone You Know Is Living in a Dementia Care CommunityWhen Things Fall ApartWhere Biology Meets PsychologyWhere Good Ideas Come FromWhere is the Mango Princess?Wherever You Go, There You AreWhile They SleptWhispers from the EastWho Rules in ScienceWhy Does E=mc2?Why Don't Students Like SchoolWhy God Won't Go AwayWhy Have Kids?Will They Ever Trust Us Again?WisdomWise Mind, Open MindWitch Beliefs and Witch Trials in the Middle AgesWitchcrazeWith Their EyesWithin ReasonWomanWomen and Mental IllnessWorking With Emotional IntelligenceWriting in FlowYogaYoga & Pilates Workouts for DummiesYoga Beauty BodyYoga for EveryoneYoga for People Who Can't Be Bothered to Do ItYoga for Regular GuysYoga for Regular Guys DVDYoga In BedYoga on DemandYoga SanctuaryYoga SculptYoga ShaktiYoga To Go's Yoga Quick Fixes DVDYogalosophyYou Are Not Your IllnessYou'd Be So Pretty If . . .Your Miracle BrainZen Encounters with LonelinessZen-Brain Reflections
Manning the front lines of mental health crises is a demanding and dangerous occupation. However, according to a recent American Psychological Association study, many psychology internships provide limited or no training in emergency psychological services. Emergencies in Mental Health Practice: Evaluation and Management, a book edited by Phillip Kleespies, seeks to fill this need. From determining if a situation is an actual emergency to how to process the outcome, it's all there. It is an excellent resource for anyone involved in emergency mental health, but what is most impressive of the editor is the insight to include issues like the right to die. Mental health professionals have expertise that may be utilized in the full spectrum of emergency patient care, and it is important to be proactive rather than reactive when major shifts in health care policy occur. Being proactive requires being prepared.
Issues in this multi-authored text include how to handle the suicidal or violent patient and how to help victims of violence. Dr. Kleespies does an excellent job of synthesizing the important aspects of emergency care, working from simple questions like "What defines an emergency as opposed to a crisis?" to " How do I manage potentially dangerous situations?" Each section of the book has experts sharing their wealth of experience and knowledge.
In the section "Medical Conditions Presenting as Psychological Crises" there is a general overview of the psychopharmacology of major classes of medications used in psychiatry. With the increasing use of medicines as treatment for mental illness, the psychotherapist needs to keep an updated, working knowledge of current medication options. Just as important is the ability to recognize their potential adverse reactions, some of which may constitute medical or behavioral emergencies. Sufficient information is given for the nonmedical professional, and the section provides an excellent review of antipsychotics, antidepressants, mood stabilizers, and anxiolytics. Also included in these chapters are some of the major medical conditions that may have psychological symptoms, such as Alzheimer's, Parkinson's, temporal lobe epilepsy, and cardiac disease. This section helps the health professional recognize the red flags indicating medical treatment is needed while the emphasis on the biopsychosocial model promotes integration of all aspects of good mental health care.
Another section, "The Impact of Emergency Service on the Clinician", explores an important issue that is not often addressed. Providers not paying attention to their own needs are soon in need of care themselves. By looking at the impact of working in an emergency setting, mental health professionals can construct a strong personal safety net. Care providers must not forget the personal toll paid in dealing with crises and the need to keep healthy in order to perform their jobs well. It is estimated that psychiatrists, on average, will have one patient in active treatment complete suicide during their career. Knowing how to handle the consequences of bad outcomes is invaluable when the inevitable happens.
The most interesting section for me was the book's inclusion of the section, "End of Life Issues." Also thought provoking was the complementary section, "Risk Management in Psychological Emergencies," which focuses on the legal aspects of providing care to suicidal and violent patients. Living in Michigan, one can not avoid the issues highlighted by the actions of Dr. Jack Kevorkian. I have guided patients and their families through the difficult decision of whether or not to withdraw life-sustaining care and have spent sleepless nights ruminating over how one can ever be an expert in this area.
While all situations are different, there are basic principles to be familiar with to provide guidance in what is the ultimate personal decision. It wasn't long ago that the Nancy Beth Cruzan case (1989) concerning the right to refuse life-sustaining treatment was argued before the Supreme Court. Now it is common place to have living wills and legal guardians placed in the position of advocating for loved ones in absentia. This is a time no person should be without proper guidance. We as mental health professionals have an obligation to have expertise in this area and to provide that guidance. End of life issues are real emergencies, especially to those faced with these situations and decisions.
What are the basic principles of end of life issues outlined in Kleespies' book? At the heart of the right to refuse treatment is informed consent, which is composed of three components -- information, voluntariness, and competency. The first component supports the patient's right to adequate information about his or her treatment so that a reasonable decision can be made. The patient is made aware of the risks and benefits of the various treatment options, the risks and benefits of refusing treatment and probable outcomes if known. The next component of informed consent is that it must be voluntary. The circumstances surrounding the consent process must be free of coercion, threats, or fraud, and the patient must not be under duress that is affecting his or her decision-making ability. Finally, there is the issue of competency. It must be noted that competency is a legal term in which a person is competent unless deemed incompetent by the courts. We as mental health professionals merely express our opinions as to competence and functional ability, but the court makes the final decision. According to Roth et al. (1977), there are five categories of tests for competency: (1) evidencing a choice, (2) "reasonable" outcome of choice, (3) choice based on "rational" reasons, (4) ability to understand, and (5) actual understanding. Mental health professionals should be intimately familiar with these principles. Dr. Kevorkian, a pathologist who does not provide patient care, doesn't follow these principles. He seems driven by some motivation other than compassion for the suffering.
The right to refuse life-sustaining treatment is grounded in the 1914 Supreme Court Ruling credited to Justice Benjamin Cardoza that "every human being of adult years of sound mind has the right to determine what shall be done with his own body." This ruling is blurred by the modern semantic issue of "allowing a patient to die" versus "euthanasia" versus "suicide." This excerpt from the PBS program "The Kevorkian Verdict" summarizes the current state of the law:
On July 26, 1997, the U.S. Supreme Court unanimously upheld decisions in New York and Washington State that criminalized assisted suicide. These decisions overturned rulings in the 2nd and 9th Circuit Courts of Appeal which struck down State statutes banning physician-assisted suicide. Those courts had found that the statutes, which prohibited doctors from prescribing lethal medication to competent, terminally ill adults, violated the 14th Amendment. In striking the appellate decisions, the U.S. Supreme Court found that there was no constitutional "right to die," but left it to individual states to enact legislation permitting or prohibiting physician-assisted suicide.
As of April 1999, physician-assisted suicide is illegal in all but a handful of states. Over thirty states have enacted statutes prohibiting assisted suicide, and of those that do not have statutes, a number of them arguably prohibit it through common law. In Michigan, Jack Kevorkian was initially charged with violating the state statute, in addition to first-degree murder and delivering a controlled substance without a license. The assisted suicide charge was dropped, however, and he was eventually convicted of second degree murder and delivering a controlled substance without a license.
Only one state, Oregon, has legalized assisted suicide. The Oregon statute, which went into effect in October 1997, provides that a doctor may prescribe, but not administer, a lethal dose of medication to a patient who has less than six months to live. Two doctors must agree that the patient is mentally competent and that the decision was voluntary. As of April 1999, 23 patients were given drugs under the statute, and 15 of them used the drugs to commit suicide. A report released by the Oregon State Health Division reviewing the first year of the law's implementation found that the law was working well and had not been subject to abuse.
At the federal level, the only legislation addressing this issue (as of April 1999), is the Assisted Suicide Funding Restriction Act. This law prohibits federal money from being used in support of physician assisted suicide. However, in 1998, House Judiciary Chairman Henry Hyde and Senator Don Nickles introduced bills in the House and Senate which would revoke the license to prescribe federally controlled drugs from any doctor who participated in an assisted suicide. If such legislation passed, doctors in Oregon, or any other state that legalized assisted suicide, would be subject to the federal sanction even though their actions were permitted under state law. The bills were not enacted into law before the end of the congressional session, but may be revived in 1999.
Although public opinion is in favor of the idea of "Death with Dignity," Kevorkian's approach is not favored. After the airing of the "60 Minutes" episode, which showed Kevorkian administering a lethal injection to 52 year old Thomas Youk, the Detroit Free Press polled viewers in Michigan and found that a majority, 45%, felt that Kevorkian should be convicted of a serious crime such as murder. Thirty percent of those polled felt he should be convicted of violating the ban on assisted suicide. In addition, when viewers were polled on the question of whether or not Kevorkian had gone too far by "trying to force the issue of assisted suicide and euthanasia by his actions, and, if necessary
starve himself in prison to become a martyr for his beliefs", 55% responded affirmatively.
Arthur Caplan, Director for the Center of Bioethics in Philadelphia, was interviewed by PBS on the issue of physician assisted suicide, and he stated that the duty of medicine is to try to talk people out of suicide, not promote it. He also commented that he worries that physician assisted suicide will become the attractive solution of first resort rather than the option of last resort. According to Caplan, "I think Dr. Kevorkian believes that the line medicine should draw around assisted suicide is neither around pain, nor around terminal illness
it must go further and that's where I expect him to be going. I expect him to be leading the charge to expand the right to die to those who say by their own free will or their own choice, "that's it for me." In psychiatry, this is called suicidal ideation and is a sign of depression, an illness that can be effectively treated in 65-85% of cases. To have thoughts of not wanting life to go on when someone is suffering may be normal, but to have the intent to take one's life through suicide definitely is not. I agree with Dr. Caplan's characterization of Kevorkian as a person who is obsessed with death, who can't accept it and who is trying to gain personal control and victory over it by saying, "I'll control the timing of it." In my opinion, suffering is the enemy in medicine, not death. Better palliative care should be the focus.
So what does this say about the state of end of life issues concerning mental health professionals? Kevorkian is not the only practitioner of physician assisted suicide, just the most widely known. There were shocking findings from a recent study out of Washington State that surveyed a large number of physicians. The results found that 16% of doctors surveyed had a genuine request from at least one patient in the prior year for an assisted death and one quarter of the doctors provided a lethal prescription. Of course, in cases like these, there is no consultation requested or provided. This issue has been around pre-Kevorkian, and it is here to stay. However, mental health professionals should be an integral part of policy development concerning end of life issues, as well as on the health care team. We are the ones to ensure depressed patients are not assisted in fulfilling their pathological intent for suicide. The medical profession has a long way to go to sort out this complex issue, and Dr. Kevorkian has helped heighten its emergency status.
As mental health professionals, we must take a leading role. Emergency situations are universal. It makes no difference whether a physician, a psychologist or a social worker is faced with an acutely suicidal or violent patient. The reality, as I alluded to above, is that mental health care needs to be a team approach, and each member can be faced with the same patient, the same emergency. How does the care team help the patient best? Each member being adequately prepared is a good place to start.
Roth, L., Meisel, A., & Lidz, C. (1977). Tests of competency to consent to treatment. American Journal of Psychiatry, 134, 279-284.
Thomas Cobb, M.D. is currently a psychiatry resident at the University of Michigan. His interests include psychiatric resident education, neuropsychiatry, theology and religious history. He has reviewed psychiatric texts for other publishers and hopes to publish in the field soon. Future plans are in academic psychiatry with a focus on integrative approaches to the patient, from neurons to philosophy.