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Leonard Fein | Cognivox @cognivox.bsky.social · 05/10/2026

The Manhattan DA indicted a psychotherapist for allegedly sexually assaulting two patients. Can NY immediately bar them from unsupervised patient contact? No. An emergency license suspension requires at least five days before a hearing. Weekends and holidays don’t count. That’s wrong.

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Leonard Fein | Cognivox @cognivox.bsky.social · 01/09/2026

"Psychiatry is a pathology of freedom: it is medicine applied to the diminishments of freedom." — Henri Ey, 1948 Ey is using the word "pathology" here to mean the study of pathological conditions, rather than as a synonym for "disease" itself. (My translation from the original French.)

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Leonard Fein | Cognivox @cognivox.bsky.social · 23/08/2026

I recently came across a distortion even worse than the "all ADHD meds are stimulants" line. An article in a literary magazine told of a patient whose "new psychiatrist gave her the Sixties housewife special: Provigil—an amphetamine ... and then Ambien ..." Provigil is not an amphetamine.

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Leonard Fein | Cognivox @cognivox.bsky.social · 13/08/2026

I take psychiatric medications. They help me. This is why I get angry when I see psychiatrists portrayed as frauds. If psychiatrists are frauds, then I am a dupe. I am not a dupe. Neither are the millions like me. #Psychiatry

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Leonard Fein | Cognivox @cognivox.bsky.social · 13/08/2026

When you hear the name of a psychiatric drug, what comes to mind? For me: Vraylar is a Norse god. Caplyta is a sports drink. And bupropion is an animatronic purple gummy bear cheerfully urging me to seize the day. What are your associations?

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Leonard Fein | Cognivox @cognivox.bsky.social · 29/07/2026

Not all the letters after a mental health practitioner's name tell you the same kind of thing. Some point to licensure. Others describe education, certification, membership, or recognition. Sort first. Decode second.

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Leonard Fein | Cognivox @cognivox.bsky.social · 14/07/2026

What did Dr. Walk think of these drugs?

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Leonard Fein | Cognivox @cognivox.bsky.social · 14/07/2026

The other day I searched the Library of Congress catalog for print books with “psychiatry” in the title. Of 3,437 results, the very first was David Cooper’s “Psychiatry and Anti-Psychiatry” (1967). The catalog has a sense of humor.

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Leonard Fein | Cognivox @cognivox.bsky.social · 11/07/2026

From my psychiatry shelves. Volume 2 was more cooperative for the camera. G. N. Christodoulou and colleagues, Ψυχιατρική [Psychiatry], vol. 2. Athens: ΒΗΤΑ Medical Arts, 2006. #Psychiatry

Photograph of the cover of a Greek-language psychiatry textbook lying on a wooden surface. The gray cover bears the large Greek title “Ψυχιατρική” (“Psychiatry”) and identifies the book as volume two. A yellow-and-blue geometric design frames two colorful brain-scan images near the center.

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Leonard Fein | Cognivox @cognivox.bsky.social · 04/07/2026

A wonderful find. I like how you point out the adjustable current. One of the many unfortunate facets of the "shock" metaphor for ECT is how it flattens and distorts what is in fact a highly tunable treatment into a binary, all-or-nothing image.

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Leonard Fein | Cognivox @cognivox.bsky.social · 04/07/2026

I agree! Part of the reason I chose to share the article is because it is refreshingly measured and medical. Sadly, as we both know, its ordinariness is itself extraordinary.

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Leonard Fein | Cognivox @cognivox.bsky.social · 04/07/2026

After a U.S. congressman earlier this week announced his recent hospitalization for depression, the NYT published an explainer on why someone with depression might need inpatient care, and what treatments they might be offered during their stay. Gift link below.

nytimes.com

For Many Americans, Depression Is Familiar. Here’s What We Know.

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Leonard Fein | Cognivox @cognivox.bsky.social · 25/06/2026

What a beautiful stack. I’ve built much of my own psych library through eBay, and it always amazes me how psych books that feel priceless to me can still be found for modest sums.

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Leonard Fein | Cognivox @cognivox.bsky.social · 03/06/2026

We call them antidepressants. An older word was thymoleptics. “Antidepressant” names the medication by what it opposes: depression. “Thymoleptic” names it by what it acts on: temper, emotion, mood. One term names the enemy. The other names the terrain. #Psychiatry

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Leonard Fein | Cognivox @cognivox.bsky.social · 28/05/2026

The line hearkens back to older, continuum-based views of mental illness that are rather obscured by the categorical lumpings one finds in the DSM and ICD.

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Leonard Fein | Cognivox @cognivox.bsky.social · 27/05/2026

In my work, "depression" is a word I see and use dozens of times a day. There is something strange about using it so freely when even a writer of Styron's gifts found it nearly beyond description. So I remind myself: though I may know the word, I do not know the thing.

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Leonard Fein | Cognivox @cognivox.bsky.social · 27/05/2026

Depression is hard to describe. The novelist William Styron called it "so mysteriously painful and elusive ... as to verge close to being beyond description." #Psychiatry #Depression

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Leonard Fein | Cognivox @cognivox.bsky.social · 25/05/2026

This is a small but consequential shift in framing. It changes who the care is for.

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Leonard Fein | Cognivox @cognivox.bsky.social · 25/05/2026

A telling passage: “The meaning and impact of depression on the patient’s family and any needs that may arise should be explored; especially regarding children, adolescents and family dependent upon the depressed patient.”

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Leonard Fein | Cognivox @cognivox.bsky.social · 25/05/2026

Most depression treatment guidelines mention the patient’s family. But few make it central, and fewer still recognize that family members can depend on the patient, not just the other way around. Spain’s 2014 national guideline is a welcome exception. #Psychiatry #Depression

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Leonard Fein | Cognivox @cognivox.bsky.social · 24/05/2026

The muddle is partly about levels. Population questions and patient-level questions are not interchangeable. “Are we prescribing too much?” is not the same as “Should this person change this regimen now?” And “how to taper” is downstream of a prior question: what is the intended aim? #Psychiatry

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Leonard Fein | Cognivox @cognivox.bsky.social · 24/05/2026

In debates over psychiatric “deprescribing,” the term has become an amalgam. It can refer to dose reduction, stopping one drug, consolidating a crowded regimen, managing withdrawal, or rethinking long-term treatment. Same neighborhood, different questions. Blurring them muddles the discussion.

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Leonard Fein | Cognivox @cognivox.bsky.social · 22/05/2026

This is not a recent posture for “Introductory Textbook of Psychiatry.” The same language is already present, in near-identical form, in the preface to its first (1991) edition.

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Leonard Fein | Cognivox @cognivox.bsky.social · 22/05/2026

Note on the 2021 excerpt: it begins mid-sentence. The full sentence starts, ‘Taxi drivers, CEOs, teachers, and ministers often feel qualified […]’

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Leonard Fein | Cognivox @cognivox.bsky.social · 22/05/2026

Sources: 1) Black & Andreasen, Introductory Textbook of Psychiatry, 7th ed., APA Publishing, 2021, p. xiii. 2) Appel, “Psychiatry and Religion,” in Arieti, ed., American Handbook of Psychiatry, 2nd ed., vol. 1. Basic Books, 1974, p. 995.

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Leonard Fein | Cognivox @cognivox.bsky.social · 22/05/2026

‘Psychiatry and religion can cooperate and supplement one another in helping people with emotional and mental difficulties and illness. Psychiatry is no substitute for religion. Religion is no substitute for psychiatry. They both contribute to the health and fulfillment of the individual.’ (1974)

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Leonard Fein | Cognivox @cognivox.bsky.social · 22/05/2026

Psychiatry and Religion in Two Textbooks: ‘[…] ministers often feel qualified to offer information and advice about how to handle “psychiatric problems” even though they may be unaware of distinctions as fundamental as the difference between psychiatry and psychology.’ (2021) #Psychiatry

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Leonard Fein | Cognivox @cognivox.bsky.social · 22/05/2026

I could not agree more with this point about ECT’s reliability. The evidence for it is beautifully stubborn: it has held up for nearly a century despite stigma, ridicule, changing clinical fashions, and adversarial investigation.

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Leonard Fein | Cognivox @cognivox.bsky.social · 22/05/2026

I’ve encountered all of these, and more. I’m increasingly convinced the answer is f.

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Leonard Fein | Cognivox @cognivox.bsky.social · 22/05/2026

What’s the most accurate metaphor for the DSM? a) Tool b) Bible c) Manual d) Dictionary e) Reader’s Digest f) None of the above #Psychiatry

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Leonard Fein | Cognivox @cognivox.bsky.social · 20/05/2026

“Treatment-resistant depression” collapses distinctions that matter. Its close cousin, “difficult-to-treat depression,” fares no better. Treatment is not a monolith. Resistance is not necessarily absolute. Nor is it a property of the disease alone. #Psychiatry #Depression

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Leonard Fein | Cognivox @cognivox.bsky.social · 14/05/2026

The textbook's sole indexed reference to lithium therapy – three short paragraphs – comes between sections on “carbon dioxide therapy” and “atropine and scopolamine therapy.” All fall under the umbrella heading of “miscellaneous organic therapies.” (Pages 1289-1290) #Psychiatry #Lithium

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Leonard Fein | Cognivox @cognivox.bsky.social · 14/05/2026

Humble Beginnings “Lithium salts have found a wide application in some countries (particularly England and Scandinavia) for the treatment of psychotic excitement, especially in manic patients.” – Comprehensive Textbook of Psychiatry, 1967 #Psychiatry #Lithium #BookSky

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Leonard Fein | Cognivox @cognivox.bsky.social · 16/03/2026

When the first Academy Awards were held in 1929, effective depression treatments did not exist. Today dozens do, and millions have benefited. Yet the image of psychiatry in cinema still mirrors that shown in Cuckoo’s Nest. The therapies have changed. The story has not. #Psychiatry #Oscars

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Leonard Fein | Cognivox @cognivox.bsky.social · 13/03/2026

In a 1987 interview, Kalinowsky was asked whether he still subscribed to the view expressed in this formulation. “Yes, I do,” he replied. This was a psychiatrist who had lived through a remarkable arc of discovery: ECT, lithium, chlorpromazine, imipramine, and the dawn of the SSRI era. And yet …

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Leonard Fein | Cognivox @cognivox.bsky.social · 12/03/2026

His is a threefold posture: meet the mystery unruffled, pursue its solution, and treat to the limits of our knowledge. Humility about causes; boldness in practice.

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Leonard Fein | Cognivox @cognivox.bsky.social · 12/03/2026

(Continued.) This state of affairs makes it all the more gratifying that active application of so many different therapeutic methods can restore the functioning of an increasing number of psychiatric patients. Kalinowsky then speaks of “constant progress” in therapeutics.

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Leonard Fein | Cognivox @cognivox.bsky.social · 12/03/2026

Psychiatry is still – exactly as at the time of the first writing of this book in 1946 – limited to purely empirical treatments of diseases whose origin remains shrouded in mystery. (Quotation continues in the next post.)

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Leonard Fein | Cognivox @cognivox.bsky.social · 12/03/2026

In the 1969 edition of "Pharmacological, Convulsive and Other Somatic Treatments in Psychiatry", the textbook he co-authored with Hanns Hippius, Kalinowsky repeated a formulation he had first set out in 1946:

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Leonard Fein | Cognivox @cognivox.bsky.social · 12/03/2026

But Kalinowsky draws the opposite conclusion.

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Leonard Fein | Cognivox @cognivox.bsky.social · 12/03/2026

At first glance, this sounds like a familiar critique of psychiatry: that its diagnoses are social constructs, and its treatments little more than pharmacological accidents whose mechanisms remain unknown. Some critics take this to undermine the field's legitimacy.

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Leonard Fein | Cognivox @cognivox.bsky.social · 12/03/2026

Lothar Kalinowsky (1899–1992) was a doyen of 20th-century psychiatry, a pioneer of somatic treatments, and co-author of a major clinical textbook. He was not shy about biological therapies. #Psychiatry · #PsychShelf

Quote card with cream background and black serif text reading: "Psychiatry is still … limited to purely empirical treatments of diseases whose origin remains shrouded in mystery." Attributed to Lothar Kalinowsky & Hanns Hippius (1969).

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Leonard Fein | Cognivox @cognivox.bsky.social · 11/03/2026

I'll be looking at how the mood disorders volume frames TCAs, MAOIs, and lithium. I love to explore how psychopharmacology treatment logic differs among various psychiatric traditions. I don't know Turkish, so I'll be using DeepL – slowly and carefully.

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Leonard Fein | Cognivox @cognivox.bsky.social · 11/03/2026

In today's mail: five psychopharmacology monographs from Turkey. They cover mood disorders, anxiety disorders, psychotic disorders, addiction, and general psychopharmacology. What are you curious to learn from them? Assumptions, treatment logic, clinical pearls? Taking requests.

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Reposted by Leonard Fein | Cognivox

Leonard Fein | Cognivox @cognivox.bsky.social · 05/03/2026

→ Marginalia: Five psychiatry textbooks, five different conceptions of where the field begins. Each revealed by a single choice: what to put first. What do you think should come first – and why? a) The patient b) The encounter c) The examination d) The diagnosis e) The brain #Psychiatry

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Leonard Fein | Cognivox @cognivox.bsky.social · 05/03/2026

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Leonard Fein | Cognivox @cognivox.bsky.social · 04/03/2026

Source for the main quotation Wilson – “A Plan for Refining the Nosology of Mental Illness,” in Martin M. Katz, ed., The Role and Methodology of Classification in Psychiatry and Psychopathology (1965), p. 53. Only the first editor is cited here.

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Leonard Fein | Cognivox @cognivox.bsky.social · 04/03/2026

Sources DSM-II (1968) – acknowledgement page Wilson obituary – Legacy.com (Washington Post notice) Bayer – Homosexuality and American Psychiatry (1987), pp. 123–124 Wilson obituary – Columbia University Medical Center Archives Archived at Perma.cc [perma.cc/9HBW-V44T]

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Leonard Fein | Cognivox @cognivox.bsky.social · 04/03/2026

Wilson also served on the APA’s Nomenclature Committee during the DSM-II era and drafted a discussion paper supporting the declassification of homosexuality from the diagnostic nomenclature. In 1986 he published a survival manual for medical students.

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