Consider these a necessary addendum to the Laws of Mount Misery by Samuel Shem:

  1. Beware the hyphenated last name.
  2. Bad therapy is far more damaging than no therapy.
  3. Alcoholism may have a genetic component, but that doesn’t make it inherently a disease.
  4. CBT is the ideal therapy for patients who don’t want to get better.
  5. Psychiatry is prone to fads: vpa, ketamine, TMS, CBT, neurontin, etc.
  6. Some of the best psych drugs aren’t initially intentioned as psychiatric (eg. imipramine, thorazine, propranolol)
  7. The nurses wield far more power over you than the doctors do on an inpatient psych unit.
  8. If a patient and their therapist agree on the brand name medication they want you to prescribe, there can be no true clinical indication there.
  9. Collusion between patients and therapists is rampant, particularly amongst the social workers.
  10. P = MD applies to most psychiatrists.
  11. If your new patient openly reports, nay, brags, that she has a history of multiple personalities she only has one and it starts with the letter B.
  12. If your psychiatrist is writing the note for your session during your session, they hate a) you, b) their spouse, c) themselves, or d) all of the above.
  13. No therapist can guide you towards a healthier place in life which they haven’t already been to/through themselves.
  14. SSRIs absolutely do numb your affect and that’s why you won’t taper down off of them.
  15. Humans foremost fear death. Our second greatest fear is change. All other fears are noise.
  16. Most intense moods are unconsciously intentional, a defense mechanism.
  17. Therapy you get for free is utterly worthless.
  18. Therapy you get for the price of your copay is worthless.
  19. Therapy you get at a sliding scale discount is mostly worthless.
  20. Therapy you pay full price for is hit or miss.
  21. The precontemplation phase is filled with people who are certain alcoholism is a disease.
  22. Shame leads to rage leads to violence. (h/t Alone)
  23. Anyone claiming to have less than two vices is either a liar or autistic.
  24. Patients get better, change, and grow only when they want to.
  25. The greatest healer is time. Get out of the way.