For more than 70 years, physicians seeking to diagnose mental-health conditions have turned to the 'bible for psychiatry' - The Diagnostic and Statistical Manual of Mental Disorders (). Last updated in 2022, and published by the American Psychiatric Association (APA), the DSM sets out diagnostic criteria for a panoply of mental-health conditions, from autism spectrum disorder to substance-use and personality disorders.
The ketogenic diet (KD) is unique in improving symptoms for many conditions, from epilepsy to addiction, according to a recent JAMA Psychiatry article. It's a high-fat, very-low-carbohydrate nutritional therapy that shifts the body's from glucose dependence to ketone production as the primary fuel source. Increasing evidence implicates metabolic dysfunction, neuroinflammation, and neurotransmitter imbalance in psychiatric and addictive disorders-domains directly influenced by ketosis.
Psychiatry may have lost sight of what it means to be normal. When every conflict earns a diagnosis, few people count as "healthy." To know normal, we must have clear empirical criteria for illness.
Two psychiatry organizations the Southern California Psychiatry Society and the recently formed grassroots Committee to Protect Public Mental Health have released statements saying that the actions of the leader of the Department of Health and Human Services have increased stigma, instilled fear and hurt access to mental health and addiction care. "As physicians committed to evidence-based care, we are alarmed by the direction of HHS under Secretary Robert F. Kennedy, Jr," the Committee to Protect Public Mental Health said in a statement.
The case comes after 200 psychiatrists threatened to resign in January, saying it was not about the money but being unable to continue working in a system causing them moral injury, knowing they were providing substandard care to their patients when one in three permanent psychiatrists positions were vacant. The doctors' union, the Australian Salaried Medical Officers' Federation (Asmof), representing the psychiatrists against NSW Health, argued the special levy was necessary to avoid the collapse of psychiatric care in the state.
I have sat with patients who tell me, " I hate these medications," and then, in the same breath, admit, " I am terrified of what happens if I stop them." Others describe a crushing sense of hopelessness, yet they still show up faithfully, week after week. These apparent contradictions are not signs of confusion or weakness. They are, in fact, the essence of being human.
My friend David Enoch, who has died aged 99, made his greatest mark as a campaigner for humane mental health care and was a founding fellow of the Royal College of Psychiatrists. In the 1960s he served as a medical adviser to Barbara Robb, the psychotherapist who exposed neglect and abuse in long-stay NHS psychiatric wards and, through her controversial book Sans Everything (1967), pushed for major reforms.
Dr Trudi Seneviratne stated that the current bill undermines the role of psychiatrists, turning them into mere checkers of doctor conclusions instead of active care providers.
"It was when I started private sessions with my therapist rather than doing them through the charity I'd been using. When I entered his private space, it was...his bedroom. He then said to me, 'Hey, you can just get on my bed and sleep, and I can watch you for an hour.'"
