Ah, Dr Pies, you do pontificate so much, er, so well, er, so usual…



Ron Pies photo 2 (1)  Dr Ronald Pies wrote an article in this month’s Psychiatric Times, which I link (fortunately, as the Psych Times does make you register at times):


Unfortunately, he does pontificate, and I can only ask readers to set aside some time and read this article and decide what you think it means.  One thing in there I have some trouble seeing as such a pervasive criticism among the net psychiatric critics is this comment:

“Psychiatry’s critics also conveniently omit reference to what was arguably the most prevalent paradigm in academic psychiatry, during the 1980s and beyond—the biopsychosocial model of Dr George Engel.6 Now, the biopsychosocial model has been subjected to much criticism, and some would argue that few psychiatrists nowadays employ the biopsychosocial model in a systematic, evidence-based manner.7,8 In 2001, Drs Glen O. Gabbard and Jerold Kay9 warned that “pharmacotherapy and psychotherapy, the major treatment modalities in psychiatry, have become fragmented from one another, creating an artificial separation of the psychosocial and biological domains in psychiatry.”

These are worrisome observations. But one thing is beyond dispute: the biopsychosocial model can hardly be reduced to a chemical imbalance theory of mental illness. As far back as 1991, in my book on psychotherapy for the general public, I wrote: “In recent years, the ‘biopsychosocial’ model of mental illness has gained prominence. This holds that mental problems have biological, psychological, and social roots. Therapy may therefore involve treatment in all three spheres.”10″

And yet, Dr Pies is one of the quickest and most persistent defenders of the APA and their current agenda, so, if my take on what Dr Pies is trying to relate is  correct, how can he defend the use of the Biopsychosocial model when the DSM 5 took the MultiAxial Classification System out??  Isn’t that what the Biopsychosocial model was built on, or perhaps more appropriately, the MACS was built per the Biopsychosocial model?  Seems a bit incongruent, or perhaps inconsistent, or, just a bit out of touch to defend both today?

At least I still have his Consult Liaison articles from the 1990′s to early 2000′s to savor, before the elitist agenda ensued.  I think the power of being an editor of a well read periodical like the Psychiatric Times either went to his head, made him sell out to his colleagues of the upper echelon in the profession, or, just dumbed him down.  As usual, I always invite him to come here and comment,  and show me where I am wrong, or at least defend his writings in a way that make more sense than how I interpret them.

That hasn’t happened so far, not holding my breath either, but, this isn’t an anonymous site, so there is no excuse not to debate an author who is clearly interested in promoting psychiatry in a healthy, responsible way.  Other readers, feel free to chime in where I am right or wrong in interpreting here.

Joel Hassman, MD

Honesty and transparency are critical to being taken seriously.



So I have posted about this story before, here they are:




Today as I surf the web for my usual haunts for newsworthy items, I found this at CNN.com, amazingly not dedicating the whole page to flight MH370, for once:


So it is being proposed the teen may have had other factors at hand, besides the bullying which the article does note was a legitimate issue to some degree.  Does having depression and being suicidal trump abuse and justify a negative outcome?

I guess if you shoot a terminally ill person, that isn’t murder.  Leave it to the apologists and defenders of abusive and disruptive behaviors to have their day in defending the indefensible.

For now I still think Rebecca was preyed on, maybe because she was presenting as overwhelmed and meek or uneasy allowed the bullies to move in for the kill.

Poor choice of words there?

CPT coding BS, here we go again!




So after reading this article in the current Psychiatric Times, by Dr Mark Komrad, who by the works for Sheppard Pratt Health Systems here in Maryland (do a google search about “controversies with Sheppard Pratt Health Systems in Maryland” sometime and see what lurks out there about this mental health monolith that is about money first at the end of the day), wanted to comment again what a pathetic and intrusive exercise this is to know what to use as billing codes.

Here are two prior posts I will offer as links to catch you up to today:


and then later,


But, just to be fair, I spent the time cutting and taping to make the article viewable to let you all read what the take is now by the author, hope it isn’t too small:




You know what, the important question is, why did the APA support this bullshit in the first place?  Dr Komrad ends the article asking “Although the new CPT coding changes might bring certain advantages, such as reflecting our role as physicians who use the same E&M codes intended for all physicians, they equally raise important ethical challenges that call for heightened  attention”.   Is that best for doctors to now have to be worried about looking over our shoulders at these auditors and other people to just snipe and challenge what we are doing, when they just make a system to create problems until proven otherwise in the first place?

You know, now that April 15th is past, just like what the IRS does to all of us US citizens every damn year?

Hope the article is worth the time to read.  I’d say enjoy, but doubtful!

How can you deny that Obama is not trying to ruin this country!?




2 different links, same damn story:


then a more partisan bent,


You partisan Democrat assholes, I have no interest to appease or dialogue with you.  I want to ask the other readers here, why does this idiot continue to delay this project?  There is no reason for the public good to claim risks greatly outweigh benefits, and I offer this to reinforce my point has validity:


Yes, there are negatives to completing this project, but, right now there are equally if not more positives, and frankly, the deeds of this criminal in the White House are deeply disturbing, he has no interest in the welfare of this country.  What is most frightening to me is there is a set 30% of Americans who support this man irregardless of what he says and does.  So, again, Carlin is right, it is not just the politicians who suck, but the public who support the incompetent, corrupt, and deceitful until death do they part.

Martial law is still a legitimate option to consider by the end of the year.  What will you do as citizens if he does this?  My bad, go back to your screens, amuse yourselves!!!

Addendum, yeah from a partisan antagonist site, but, read it and wonder if there is more to the point than just my ranting as a concerned citizen:


One of the more shocking events illustrating the growing strength of al Qaeda is the release of a video this week showing what CNN reports as “the largest and most dangerous gathering of al Qaeda in years.” It’s what experts think is a recent gathering of the terrorist group’s leadership and more than 100 fighters in Yemen.

For an administration that does not hide its eagerness to use drones to kill terrorists, experts and journalists alike were wondering whether our intelligence community knew about this meeting, and if so, why didn’t they take the opportunity to kill the most dangerous of them with one drone strike?”

then this, “The dangerous circus created by the Obama regime’s rules doesn’t stop there.

Sept. 11 victims’ families are asserting they think the Obama administration is deliberately sabotaging the trials at Guantanamo, and insist the FBI is meddling in the cases, according to reports in the Free Beacon.

Unfortunately, both Mr. Obama and Attorney General Eric H. Holder have a history with the American people that not only doesn’t engender trust, but suggests efforts that are directly harming the nation and the American people, while pushing an agenda benefiting the terrorists.”

and ends here, “It is a horrible thing when Americans have to consider the possibility that the leadership of this country is purposefully acting in a manner that benefits our nation’s enemies. Yet, when we look around the world, those feeling and acting empowered are the bullies, tyrants and terrorists.

The American president does have power, including the sort that signals to the world’s beasts that they can do as they please.”

Hey, I didn’t write that stuff above in bold.  Think about it.

Welcome to the American Health Cost System. Not a typo there, “COST”, not care!




So, what do you conclude from this article?


“We understand that we doctors should be and are stewards of the larger society as well as of the patient in our examination room,” said Dr. Lowell E. Schnipper, the chairman of a task force on value in cancer care at the American Society of Clinical Oncology.”

and then this, “Dr. Steven D. Pearson, a visiting scientist in the ethics department at the National Institutes of Health, said the move by some societies to incorporate economic analysis “heralds an important shift in the way doctors in America are talking about cost and value.”

He said that having societies do such evaluations was better than having a doctor make such trade-offs while treating an individual patient, which is sometimes called bedside rationing.

Still, it is unclear if medical societies are the best ones to make cost assessments. Doctors can have financial conflicts of interest and lack economic expertise.”

So, while I respect and accept that physicians have to consider the role of cost to care interventions, is that what should be front and center in the intervention process?  No, but, you idiots who want Obamacare to continue on as is, that is what politicians want of this legislation, and the indoctrination has begun.

At the end of the day, if things stay as is, do you want your doctor to recommend a treatment because it is appropriate and fits your care needs, or, it is the cheapest option first?

Let Obama and his minions direct the patient-physician interaction, well, you might as well pull out your wallets/purses and then decide what you want to get for care.

Oh, my bad, what you want for cost!

Tired of addendums for the Pelletier case.


You should know that I have been posting onwards about the Pelletier situation since last month, but, I doubt most readers have bothered to go back and read what I have been noting since the story hit the airwaves en mass that time.  First, here is my earlier post to let you catch up:


Now, here is something Dr Keith Ablow wrote today:


Ends with this:

“Yet, I also know that a teenager has been taken from her family. I know that she was once a figure skater and has, since her time at Children’s Hospital, been photographed in a wheelchair. I know that she reportedly passed a note to her parents recently that accused the hospital of abusing her. And I am absolutely sure that if the medical records or other evidence cannot prove beyond a doubt that Linda and Lou Pelletier placed Justina in mortal danger by virtue of their psychopathology or willful negligence as parents, Children’s Hospital should be brought to its knees by paralyzing civil suits and criminal complaints, and the Commonwealth of Massachusetts should be exposed for what it may have become: a state that, under the determined leadership of Gov. Deval Patrick (who, by the way, threatened to jail anyone driving during a snowstorm this winter), teeters on the brink of abandoning all pretense of individual freedom.”

watch the video at the top of the Ablow link, illuminating how the pathetic fuck ups by all involved representing Massachusetts are killing this teenager and destroying this family.

If you live in Massachusetts, be afraid, be very f—–g afraid!!!

Addendum April 18 PM:

see the first comment at this post, very interesting that the Boston Marathon Bombing terrorist charged with killing and maiming US citizens has more rights than the Pelletier family.  Shows you what is the political agenda of the Left these days.  Obama is a cretin, and he is a leader of a sizeable portion of his party.  Manchurian Candidate agenda folks, just not flagrantly assassinating people.  Yet!

The silence from the Massachusetts politicians is deafening!

Further addendum today 4/18:

link to educate:  http://www.theblaze.com/stories/2014/04/15/shocking-note-apparently-penned-by-justina-pelletier-to-her-parents/

See what this evokes in readers:  “Pressed for more details about the note, including why some of the content was cut off at the top in the image provided, Lou Pelletier became animated, frequently citing his frustration with the case and said published news reports seem to have resulted in DCF crackdowns on allowing Justina to communicate with them.

“She’s being allowed to be tortured in this country, I’ll leave it at that,” he said.”

and later in there this, ““Sadly, Justina’s own words paint a picture of mistreatment by DCF that we can see for ourselves,” he continued. “Fourteen months ago, when she was removed from her home, she was taking part in ice-skating competitions and living an active life. Under the care of DCF, she is in now a wheelchair and can barely walk. She has not been allowed to attend church, and has not been given her individualized education program which is required by federal law.”

Again, if this child dies, who will be accountable?  Everyone who prevented her release back to her parents, and that includes the loser titled Governor of Massachusetts.  How do you citizens of this state live with yourselves, much less in that state?  Oh, I forgot, you vote for these morons to allegedly represent you, so you get what you deserve!  George Carlin was right, it isn’t the politicians who suck, but, the public!



Evil shit going on in Massachusetts, and it just continues!

Addendum April 19:  yeah, kind of ironic to title the post “tired of addendums…” and then doing addendums, but, this is a story that is not going away, and even after Justina is released back to her parents (hopefully on her legs and not in a box!), the fallout from what the legal system did and what the political system did NOT do, well, I really hope people are chronically unemployed and shunned for the rest of their lives for this case alone!

Anyway, the point to this addendum is for the legal junkies interested:


This Judge Johnston, I think there is enough evidence to show a challenge to his competency to stay on the bench for the questionable rulings he has made even before the Pelletier case.  Isn’t it time for the US to consider that judges need to be retired by a certain age?

Just my opinion.

Oh, and here is the best I can find about Judge Johnston, and isn’t that a red flag his background is so secret, while yes he is a judge, we don’t even have a basic bio to read how he got to the bench at least?!


“Let’s start by pointing out what no other news site has: where did the information about Judge Joseph Johnston go? It was posted on the official Mass.Gov website, but the information about him, including his picture, have all disappeared. Anyone who thinks about this should be both shocked and afraid. As you can see for yourself if you search the Mass.Gov website, the Commonwealth of Massachusetts has hidden all information about “The Cowardly Lion”, Judge Joseph F. Johnston. Here is what Lawyers Weekly posted about Judge Joseph F. Johnston:

By: Mass. Lawyers Weekly Staff July 9, 2001 Circuit Justice Juvenile Court Three Center Plaza Suite 520 Boston, MA 02108 (617) 788-8542 Born: 1958 Year admitted to bar: 1985 Year appointed/elected: 2001, by Gov. Jane Swift Education: New England School of Law, 1985 Fitchburg State College, 1980.

When a person is proud of his actions, he rightfully stands up and takes a bow. When a person is caught with his hand in a cookie jar, he can choose from two paths; run and hide, or admit his mistake, and hopefully not make the same mistake twice. When people choose to run and hide, or worse, repeat their mistake, that speaks volumes about the content of their character.”

Well, at least something now, but, the last paragraph there, I definitely agree with that, the deeds do show what the agenda is, so running and hiding reveals much to a person’s character.

Derek Hunter to the rescue!




Thank you so much, Mr Hunter, you made my night after a real bitch of a work week.


It is such a great column, you read it:

“People have been saying the country is “going to hell in a handbasket” for decades. It’s sort of a rite of passage for every current generation to look at the next one and think it will screw up things so badly everything will be ruined. But the handbasket this current generation is creating may well be the one that sinks us.

Every generation is the product of the previous one – its culture, morals, priorities, everything. In the 20th century, that meant passing on a work ethic, the importance of family and the American Dream that each generation will do better than the last. That optimism hit a wall with the baby boomers.

Baby boomers, the generation born between 1946 and 1964, are the current leaders and, as such, set the tone for what comes next. The example they’ve set as the “me generation” planted the seeds for what we’re seeing now in the news, and those images do not bode well for the future.

Baby boomers pioneered the “if it feels good do it” mentality prevalent in the ‘60s and ‘70s – sex, drugs and rock and roll; a lifestyle that lived for the “now,” future be damned. They seemed to lack an appreciation for consequences; the hangover never sets in if you don’t stop drinking.

But the bills will come due; the piper must be paid.

Baby boomers are the credit card generation, living on money borrowed – taken, actually – from their children and grandchildren. They’re also the generation that placed emphasis on self-esteem above all.

High schools and colleges across the country have, and are, graduating little monsters who’ve never heard the word “no,” who’ve been told they’re never wrong and every choice is equally valid. These kids don’t have parents, they have “best friends.”

Parents aren’t solely responsible for this, although they are individually responsible for their own children. The culture they created, accept and celebrate is the main culprit.

We once celebrated success. Now, we simply elevate being. We once shunned certain behaviors; now, they are the yellow brick road to the future.

Andy Warhol famously said “In the future, everyone will be world-famous for 15 minutes,” and he was nearly right. Nearly because “famous” is no longer a result of actions; it’s the goal. Celebrity is heroin, and we have a generation entering adulthood as addicted as any junkie.

Talent or achievements are no longer required for fame; it’s now as easy as being willing to make an ass of yourself on video and post it online. Successful people in the working world were once admired and held up as positive examples; now they are the object of scorn and ridicule. Unwashed children of privilege “occupy” parks and protest at their homes while networks cover these actions as if they’re accomplishments.

The media is an unindicted co-conspirator in the dumbing down of the future. It’s not just the news media – though it’s possible to watch all three major network newscasts and not learn anything worthwhile – it’s all the media. We are collectively dumber for knowing what a “Snooki,” a “Chrisley,” or a “Honey Boo Boo” are. How many brain cells committed suicide rather than be dedicated to remembering which inflated bimbo the vacant Juan Pablo hooked up with? Paris Hilton and Kim Kardashian would’ve been cautionary tales 20 years ago; now they make millions for existing. The collective IQ of “reality TV stars,” musicians and celebutantes is dwarfed by the number of teeth in the mouth of a newborn baby, yet these are people admired by tens of millions of people who will assume the reins of power in the not-too-distant future.

People magazine doesn’t outsell every news magazine in print by accident, it outsells them because it is more interesting than news magazines. Why drink no-brand cola when Coke is available?

Self is all-encompassing – but it’s not the individual, it’s the collective “self.” The pursuit of attention, the need to make everything about “me” is overwhelming people now. If it isn’t shared on social media it didn’t happen.

Twitter and Facebook are the Holy Grail of this new narcissism, and we’ve all been ensnared in it to one degree or another. Having a good meal? Post a picture of it or it didn’t happen. Have a thought on a news story? Tweet a link or it doesn’t matter. Have a solid bowel movement? Well, you get the idea.

We are over-sharing like a drunken uncle at the family Christmas dinner talking about his ex-wife, and there will be consequences.

Recently, the president of the National Organization for Women clumsily tried to make to make an irrelevant point about how bad employees have it nowadays. But in the process, she accidentally made a good point. She told MSNBC employers have an advantage, “They know everything they need to know about their employees … all they have to do is go on Facebook.” She’s right, but who put it there?

If you smoked a joint with Snoop Dogg last weekend, it will make for a fun story to share with friends. But when you share it with the world, complete with pictures, it may have consequences when it comes to getting a job in the future. Stupid moments are fleeting; the Internet is forever.

When a student went on a stabbing spree in a Pittsburgh-area school, one of his victims posted a picture of himself in his hospital gown on Instagram. The “stabbing selfie” brought about a small firestorm of criticism, but it’s what society created.

Reality is being reduced to a series of 140-character tweets and a “like” button. Get punched in the face by a comedian? Don’t defend yourself, tweet it! A madman shooting up a mall? Forget getting to safety, the world must know your every thought.

There is nothing not shared on social media anymore – from births to birthdays, dates to break-ups. Everything is fodder for the attention monster we’re all becoming. Facebook is full of profile pictures featuring everything from people’s most intimate moments to their latest appearance on cable TV as if they’d cured cancer, Foursquare lets the world know where you are at any given moment. It’s hard to tell if people truly are upset the NSA is tracking their every move or if they’re simply mad the NSA beat them to the punch. Privacy isn’t being stolen as much as it’s being voluntarily traded for a quick fix of micro-fame.

We have become a nation of narcissists – attention junkies measuring our success by the number of Facebook friends and Twitter followers we have rather than our accomplishments. None of us are immune – to one degree or another we’ve all been affected by this attention seeking. What that will mean when the next generation assumes power remains to be seen, but it can’t be good. I opine about it regularly on Twitter. Give me a follow!

NOTE: I wrote this column Tuesday night. After I submitted it, as if to add an exclamation point, the White House tweeted an Obama/Biden selfie. I couldn’t make up a more perfect illustration of my point.”

The picture at the top is from that last link in blue the line above this.

Priceless, this picture and this post are just priceless.

Cue the Lion:



(I think this is Obama’s theme song of late!)


” “I am telling…


” “I am telling you if there is a God, when I get to heaven I’m not stopping to be interviewed. I am heading straight in. I have earned my place in heaven. It’s not even close,” Michael Bloomberg said.

Um, someone needs to let Mr Bloomberg know that people of extreme arrogance and self serving agendas earn a place in the afterlife, but, I think he is confusing heaven with another place that starts with an “h”, rhymes with “swell”, and certainly won’t worry about letting those who belong to just walk in and get settled.

What an idiot, but, this is what narcissism of billions of dollars does to people.  By the way, you are right, Mr Bloomberg, it isn’t even close, you are going to have an eternity to realize how much you blew it!

Frankly, I have no interest in an apology or clarification from him or any of his apologists.

You have got to be kidding?!


Don’t know if I can do a post with my level of comfort and reliability here at the hotel computer, but I’ll try!


you have to read this story I read this morning, courtesy of the Comfort Inn free USA Today Paper I found it in:


Really, a vending machine for getting pot?  Where the hell are the beer vending machines in this hotel?!  That would be more realistic as a start before the pot spots!


The difference between “FREE” versus “FEAR” is more than just a couple of letters or their arrangement.




I saw the new Captain America movie with my kids today, and while I can’t replicate the dialogue between the Robert Redford character and the Cap, there was a comment early on about the difference between “Free” and “Fear”, and that resonated in me for the rest of the day.

Hasn’t this country really screwed up the past 13 or so years after 9/11 and allowed FEAR to be a rationalized substitute for FREE, the latter in the sense of Freedom.  Frankly, so many elements of our culture have bought into this so fully and completely, I really don’t think people have realized that allowing others to take near total control with the alleged intent of lowering fear thus allowing these others to take away being free is just stupid, but also dangerous and damaging.  Isn’t there some inherent fear to be truly free at some moments, because we can’t predict what real freedom and choice will lead to, but, that is life.

I think psychiatry has traveled this path, allowing the fear of intrusive elements that had no business settling in and directing the profession just because these intrusive elements had some impact on money, and choice.  But, I really think too many people are just whores and cowards in my field, and they operate on fear very well.

So, just making an observation about the words “fear” and “free”.  Amazing what just a change in a letter and the arrangement of the word can have such a profound impact on the outcome of the concepts.

Or, how two words can be so different in that one is primarily about a principle, the other an agenda.

What drives you to be who you are and what you desire and strive to be ongoing?  Principles or agendas?  There are people out there who will tell you which are more important, I guess you just have to decide who you have the greatest faith will do you well at the end of the day.  Me, I think it starts with yourself and integrity and consistency, then paying attention to the deeds by those around you.

Good luck in your decision.


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