The recent murder cases of Annie Le at Yale, possibly by 24-year-old Yale lab technician Raymond Clark, and of Trisha Leffler by accused Craigslist killer Philip Markoff obviously took the lives of two young women and shattered the lives of their families.  I have treated parents of murdered children, as well as their siblings, and know that the surface scars may fade over time, but that the internal emotional bleeding—the complicated grief—never seems to end. 
 
Less attention is paid to the other victims of such horrific crimes—the families, girlfriends and friends of the killers.  Both Raymond Clark and Philip Markoff were not only the sons of mothers and fathers, but both men were engaged to be married.  In both cases, if convictions are obtained, their fiancés are left to pick up the pieces of their psyches, battered by the knowledge that they had loved and committed themselves to men who were pathologically violent.
 
When one’s son or daughter, husband or wife, or fiancé turns out to be a stranger full of darkness, it is a reckoning with reality like few others.  I have counseled such individuals and seen the tears in their eyes and the stress in their faces as they tried to make sense of how someone seemingly so close to them could have been, in fact, infinitely far removed. If people who profess their love can keep their darkest truths under wraps, who and what can be trusted in the world?
 
Many, many people know something about the challenges that face the “survivors” of intimate connections with murderers.  After all, my practice has long been populated by those who were injured by assailants who played the role of parents, teachers and mentors. Their ability to trust is often long in being reborn, relying not a little bit on how trustworthy and reliable I can be as a clinician.  Such is the miracle of human empathy:  the example of a decent, caring relationship can mend some of the damage done by a harmful one, even a predatory one.
 
Yet to have lived with or loved a killer is a special case.  The journey back from that kind of terror and self-doubt has several ingredients.  First, it has to be said that there are among us men (and women) who can indeed wear what the great psychiatrist Hervey Cleckley called a mask of sanity.  Having buried their destructiveness and rage deep inside them (until it explodes) they become people imitating people, doing those things that seem kind and respectful, without feeling kind or respectful.  They are playacting, and they can be better at it than the best actor in any movie.  Scott Peterson, who killed his wife Laci and their unborn son Conner, was such a man—likeable, with good manners, able to win women over with one-liners harvested from movies and chilled champagne tucked in a backpack for a romantic hike.
 
So those who share their lives with killers can take some solace in the fact that many pass themselves off as normal, even to law enforcement officials and psychiatrists. That’s the easy part.
 
The harder part is understanding that there can be a reason why those who turn out to have loved killers find themselves in that rare psychological territory.  And often that relates to their own willingness to distance themselves from core feelings of anger and anxiety and accept the surface of things. Very often the lovers and best friends and even parents of killers have had traumatic life experiences that paved the way for them turning a blind eye to their emotions and instincts, making them the ideal partners for predators. 
 
Predators can sense when they are in the presence of others who will take them at their word. 
 
Like most of our emotional challenges in life, the biggest hurdle to healing for those with a killer in the family is looking inside themselves, at the very things they have tried to avoid seeing.
 
Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement including www.livingthetruth.com. Dr. Ablow can be emailed at info@keithablow.com.

With hip New Yorkers focused on Fashion Week, including the designers setting trends and the models bringing them to life, many experts are warning that the skinny women walking runways are not only at risk for eating disorders themselves, but could cause eating disorders in the young women who admire them in magazines and on television.
 
I disagree—at least with the latter concern.  Certainly, women (and men) who make their livings by marketing their physical presence—and being acutely aware of how others are reacting to them—may be more prone than others to psychological disorders connected with self-esteem and unresolved emotional turmoil deep beneath the surface. This not only includes anorexia and bulimia, but conditions like depression, panic disorder and substance abuse. The same could be said, however, of those who gravitate toward the acting profession or any other career in which success is partly determined by the way the person looks in front of a camera.
 
I do not believe, however, that young women who see thin models in magazines or on television become eating disordered based on those images.  In order for anorexia or bulimia to take root, a woman has to have a pre-existing vulnerability of brain chemistry or a life history of emotional turmoil or both.  Seeing thin models in Vera Wang or Calvin Klein won’t distort the body image of those whose self-perception has not been made fragile, whether by complex psychological dynamics or complexities of neurochemistry.
 
For me, part of the evidence that thin models don’t spread eating disorders is that fashion designers use these women to market to all consumers, not just the ones who are razor thin.  The marketplace is still a pretty smart barometer of the American psyche and that means that, like it or not, women who are size 12 are just as likely as size 2 women to be motivated to buy clothes worn by today’s “Twiggy.”  And America is getting fatter despite our collective ideals of beauty, not slimmer. 
 
If size zero fashion models cause anorexia, why have decades of exposure to them resulted in an epidemic of obesity among young people.
 
I maintain the same position about violence in movies.  No amount of watching violent films can make otherwise healthy people turn into thugs or killers—any more than watching films about heists turns moviegoers into thieves.
 
I believe the same can even be said for advertising of alcohol and cigarettes.  The advertising itself doesn’t create addicts.  The desire to be repeatedly intoxicated by alcohol or nicotine resides in the brain chemistry or life circumstances of the users, not within the text or photographs of what is used to promote their drugs of choice. 
 
There are many powerful and toxic influences that fuel the millions and millions of cases of eating disorders, mood disorders, anxiety disorders and substance abuse disorders in the United States.  The most significant of those influences, however, are to be found not in the magazines we read or the television programs we watch, but in the disintegrating and traumatic relationships that unfold right in our homes.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement including www.livingthetruth.com. Dr. Ablow can be emailed at info@keithablow.com.

Elizabeth Bernstein, writing in the Wall Street Journal, astutely observes that the promise of Facebook and Twitter—to bring people closer by putting their lives online, with up-to-the-minute updates—can have the opposite effect.  Many people, she writes, use “friending” and “tweeting” as a surface and synthetic way to talk about the fun outings they’re planning or the fact that they just closed another sale at work. 
 
“I’m tired of loved ones—you know who you are—who claim they are too busy to pick up the phone, or event write a decent email,” Bernstein writes, “yet spend hours on social-media sites, uploading photos of their children or parties, forwarding inane quizzes . . . or tweeting about their latest whereabouts.”
 
That’s just the beginning from a psychological point of view.  Facebook and other social-media “destinations” not only provide cover from more genuine and intimate human interactions, they can encourage people to present themselves as actors in their own semi-made-up life stories.  They can remove people from reality, heightening their narcissism (which we all have, to a lesser or greater extent), making them not only self-obsessed, but intent on projecting a multi-media fictional representation of how happy and successful and social they are. 
 
As Marshall McLuhan wrote, the medium is the message.  There is no avoiding the fact that social-media sites call upon members to use a keyboard, hard drive and computer screen, together with photos, video and words to create evolving autobiographies for “broadcast” on the Web.  This very process creates a kind of dual existence, consisting of one’s real life and one’s life on-line.  The online version can pull people away from their deepest thoughts and emotions and relationships—from what constitutes their real selves—into the abbreviated or evasive or attention-grabbing kind that can be packaged for mass consumption. 
 
This is more than an academic concern.  It’s a human and clinical concern.  The distance between a person’s contrived self and real self is the growing place for anxiety and depression.  Today’s social-media sites can expand that distance until, distracted too long from the noble and, ultimately, healing battle to understand oneself and others for real, swells of genuine emotion feel like tidal waves. 
 
Indeed, I have already worked with several clients for whom using social media sites has, in and of itself, coaxed them away from the truth about their lives, toward a kind of technologically intoxicated vacation from it.  Together, we struggle to take the journey back.
 
Anatole Broyard, the late and great NY Times book critic, once wrote, “Inside every patient, there’s a poet trying to get out.”  We could now add that behind every Facebook profile, there’s a real life story just waiting to be told.  
 

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s Web site at livingthetruth.com.

Jaycee Duggard, now reunited with her family after being held captive for 18 years by convicted sexual offender Phillip Garrido, is reportedly struggling with symptoms consistent with Stockholm syndrome.

During her ordeal, which began at age 11 when she was kidnapped by Garrido, she has apparently bonded with him. The term Stockholm syndrome was coined by psychiatrist Nils Bejerot, who assisted police during the robbery of a Stockholm bank. The robbers held bank employees hostage for just six days. Yet that was long enough for the hostages to become emotionally attached to their captors and defend them to police, even after being freed. Duggard was held hostage more than 1,000 times as long as the Stockholm bank employees.

She was alone much of that time, not part of a group. There was no hint that anyone was searching for her. Her first sexual experiences were almost certainly with Garrido. She bore him two daughters. Her survival and theirs depended, every minute of every day for 18 years, on acquiescing to him and pleasing him. He was not only her kidnapper and rapist, but the man who kept her fed and clothed and kept her makeshift hovel dry when it rained. When she wept, it may have been he who comforted her and reassured her that everything would be alright—because he loved her.

The human mind is resourceful. It can conjure comforting fictions to protect itself from realities that would, if seen clearly, lead to unbearable fear, despair, sadness, insanity or suicide. The fact that you are an 11-year-old girl, safe at home, snatched off the street, never to see your parents again, held by strangers who can punish you ceaselessly at their whim, as severely as they see fit, day or night, is simply too much truth to live with.

So it is understandable that that 11-year-old would eventually grasp for anything that felt like safety, even the myth that her kidnappers were, for example, sent by God to take care of her, usher her into womanhood, give her a family and make sure she was never again exposed to the darkness and danger of her prior, sinful existence. Jaycee Duggard’s road back depends upon the mind’s agility, too. Because now she must see that she was in danger from predators who posed as her saviors. She must somehow find her original sense of self, revisit the horror it must have been to cede all control to her assailant and take the journey from viewing herself as a helpless victim to seeing herself as a survivor.

While I am not treating Jaycee Duggard, I have helped hundreds of people take this journey. Because her story—while far more dramatic—is a cousin to every story of an abused girl or boy who clings to parents who are that only in name and not in deed, parents who erode self-esteem by inflicting emotional or physical suffering on their offspring. These children, like Ms. Duggard, fear they will be abandoned or that they are unlovable and they ally with their “captors,” too. Only from the relative safety of adulthood, in a healing and therapeutic relationship, are they able to admit the terrible truth that what they took for love all through childhood was never that, and that finding what they need in the world will mean seeing what was unfairly denied them. Stockholm syndrome, it turns out, is far more common than most people think. It doesn’t take a bank robbery or an abduction to trigger it. It happens in many, many “homes” that are that only in name.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s Web site at livingthetruth.com.

Ryan Jenkins was a famous reality TV star.  He had appeared on the VH-1 series Megan Wants a Millionaire, winning the $1 million prize.  He was selected for the third season of the VH-1 reality show “I Love Money,” and reportedly won the $250,000 prize on that show, too (which apparently will not air). 
 
What Ryan Jenkins really was in reality (as in, real life) was a violent man who had been sentenced to 15 months probation and ordered to complete domestic violence counseling after assaulting his girlfriend during 2007. He also was apparently capable of killing his ex-wife Jasmine Fiore and then removing the tips of her fingers and her teeth, in an attempt to prevent police from identifying her (which they ultimately did, ironically, by tracking the serial numbers on her breast implants).  He then fled and hung himself from a coat rack in a motel room in Canada.
 
The underlying character of a man asserts itself eventually, no matter how many scripts he is handed or how well-honed his acting skills.  
 
The truth is that most reality television shows have nothing to do with real life or with real emotions or with real people.  Most showcase situations that never occur in our genuine day-to-day existences and run the risk of attracting participants who are on the run from their feelings, not at one with them.  These “stars” are often quite different from actors like DeNiro or Pacino or Streep.  They aren’t practitioners of any particular art form and don’t know the first thing about getting into and out of character.  And they might not need to because they are always acting.  They may be particularly good at what they do because they lack a core self and can adapt to the unreal, real-life predicaments into which they are written. Their narcissistic needs for approval and applause and fame and their lack of a desire for privacy may, in fact, be intense enough to qualify as psychopathology.  They run to fake dramas because they have been running their whole lives—from core sadness and rage and shame.
 
Ryan Jenkins was gifted as a reality TV star because he was a tortured human being.
 
Just think about Jon and Kate Plus 8 “playing” parents to sextuplets by putting them before the lens of a camera that can’t help but distort their developing emotions and perspectives.  Great parenting there, huh?  They qualify as reality TV stars because they aren’t real parents, not because they are.
 
The real, real Ryan Jenkins was a person full of rage and self-hatred who terrorized more than one woman, killed his ex-wife, then hung himself.  If he had managed to live longer without taking any lives, he probably would have won some more prize money and gotten more famous.

Postpartum depression is well-known in women who have given birth.  As many as 15 percent of new mothers may experience all the symptoms of major depression in the months following a delivery.  These symptoms can include low mood, low energy, tearfulness, altered sleep patterns, changes in appetite, inability to concentrate, low self-esteem.  They can even include suicidal thinking or bizarre and false beliefs called delusions, which are a form of psychosis. 

Thankfully, awareness of postpartum depression in women has increased dramatically amongst clinicians and the general population. 

What many fewer people realize is that new fathers can fall victim to postpartum depression, too. In my own practice I have seen it happen several times, and research indicates that perhaps 10 percent of men become acutely depressed in the postnatal period.  Their symptoms mimic those of women with the disorder, but they may be even less likely to get help because they believe admitting to their suffering would make them look weak at a time when they want to be seen by others as especially strong.

In the men I have treated, the joys of having a new son or daughter have mingled with complex worries about whether they would be able to support larger families, whether they would lose the affection of their wives and whether they would be equal to the daunting task of being role models for their children.   For some, becoming fathers seemed to bring them uncomfortably in touch with their own mortality, as they contemplated being survived by their offspring.

I have noticed a particular vulnerability to postpartum depression in new fathers who had strained or frankly painful relationships with their own dads.  The recreation of a father-child bond, albeit in a different time and place, with a very new role, can bring a man into unbearably close contact with unresolved conflicts from his own childhood.   “How am I supposed to be a father when I wasn’t fathered at all myself?” one of my patients asked me.

Fortunately, postpartum depression in men responds to the treatments that relieve clinical depression in other settings.  Psychotherapy can be invaluable, as can antidepressant and anti-anxiety medications.  A new technologies, called rTMS (repetitive transcranial magnetic stimulation), has also been approved by the FDA. 

Using the tools in our therapeutic armamentarium, psychiatrists can defeat depression in over 90 percent of cases.  That means that recognizing the signs and symptoms of the condition is half the battle. 

So if you know a man struggling with his mood and his energy level weeks or months after his partner gives birth, don’t assume it’s all about staying up with the baby. Share what you now know about postpartum depression:  It doesn’t just affect new mothers.

Great leaders and great political movements have a lot in common with the finest therapists and best psychotherapy: 
 
1)   They are relentlessly courageous about exploring that which might otherwise remain under cover—that which might otherwise be accepted as true without real inspection and understanding. 
 
2)   They practice a kind of quiet and reflective, yet insistent and intellectually piercing non-cooperation with liars and lies.
 
3)   They are colorblind and blind to socioeconomic status.  They see people as individuals with worthy thoughts and rich life stories, regardless of whether they are black or white, penniless or affluent.
 
4)   They are non-violent, whenever any alternative exists, which it almost always does.
 
The high ground in the health care debate and the debate over whether we remain a capitalistic society or a socialistic one will be taken and held by that group that adopts these four principles. 

Presently, I believe that the opponents of massive, unexamined changes in the health care system, a reduced level of autonomy as citizens and a powerful parental role for government in private industry and private affairs occupy that ground. Oddly and surprisingly, it is this group—the vocal opposition in town halls and at tea parties, the relatively well-heeled and well-healed group that activists have labeled insensitive in the past—that is exposing the limits of the present system to remain open to every idea and give every man and woman a fair hearing (not just those who claim to be disadvantaged or disenfranchised).  It is this group that is being met with walls that urge them to just wait and see, or just shut up, or just go away. 
 
So it is time to be doubly sure that the vocal opposition remains the loyal opposition. 
 
It is time to be triply sure that the opposition remains non-violent. 
 
The right to bear arms, which will also be under assault soon enough, should be held dear and married to the greatest reticence imaginable to use them. 
 
We are all learning together that the tools of change that once opened doors to minorities and to disempowered and worthy peoples all over the world are the very same tools that can keep in place the worthy structural beams upon which our great society was built. 
 
If leaders turn out to be reluctant listeners, protesters should speak in greater numbers, in more places, with more clarity and creativity and insistence, but never with hatred and never with fists clenched or one hand on a stick.  Let the frustrated purveyors of falsehoods and enemies of freedom use those tactics.  They always fail.
 
The psycho-political lessons learned from those shut out of the system must now be adopted to save the system.
 
There’s something elegant and inevitable about that.  The truth always wins—in public policy and in therapy.

Just when I thought Joe Jackson (Michael’s “father”) might be my poster boy for reprehensible parenting, you’ve come along to challenge him for the honor.  According to media reports, you tried to pick up your own daughter Tatum at Farrah Fawcett’s funeral, with the one-two punch, “You have a drink?  You have a car?”
 
You are quoted as telling Vanity Fair contributing editor Leslie Bennetts, “I’m a hopeless father. I don’t know why.  I don’t think I was supposed to be a father. Just look around at my work—they’re either in jail or they should be.”  You go on to say that you aren’t in touch with your children any longer and have “never been happier.”
 
Here’s a psychological newsflash:  Not recognizing your own daughter is the kind of thing that gets etched on your tombstone, under the heading SCUMBAG.  Trying to pick her up at Farrah’s funeral—or any woman’s—goes right underneath that entry.  And stating publicly that you’re happier not seeing or speaking to your own kids makes it a Trifecta.  You’re gonna keep some guy who etches letters in granite very busy.
 
No wonder Tatum was hooked on heroin and Redmond is in jail for a drug offense.  You obviously have a really bad habit of inflicting pain on people, and they turn to one or another intoxicant to try to relieve it. I mean, it’s one thing to try picking up your adult daughter, it’s another to do whatever you did to her as a little girl.  Exactly what was that, Ryan?
 
I know, you think I’m being a little hard on you, but I’m not. 
 
See, when I use the term “scumbag,” I mean it in the clinical sense, and with no hatred toward you, whatsoever.  I mean that something happened to you in your own personal development that led you to think so little of yourself and so little of others that you can’t see the beauty it is to bring a new life into this world and be able to nourish it.  You must question your own self-worth so deeply that now the only thing you can pay attention to is how to pump yourself up narcissistically and avoid the deeper questions you have about whether you’re worth anything at all—to yourself or anyone else.
 
You tell Ms. Bennetts that you’d “take back” your kids—as in, return them to their Maker; as in, kill them off.  Well, you came close, setting them up for their drug abuse.  But here’s the thing:  The real ambivalence you have at core isn’t about them at all.  It’s about you and whether you deserve to exist.  I don’t believe you could have been well-loved and turn out unable to love.  Your own family somehow made you wonder whether you deserved to be born, whether you were really a keeper.  How?
 
You did deserve to live. You were once an innocent child, full of human potential and the capacity to love yourself and others endlessly.  You were cheated of that potential, and I am sorry that happened to you.  Now, facing the particular traumas you lived through and feeling all the pain of having lived through them is the only way back to being fully human.
 
Life is an amazing journey and, even with you facing leukemia, the end isn’t written until a man’s last acts and final words.  You can still reclaim your humanity and capacity to love and offer it to the children you brought into this world.  And then very different words might mark your resting place and very different things may be said of you.
 
I have seen people resurrected by embracing the truth at 18, and at 48, and at 78.  It is never, ever too late. 

President Obama lost something invaluable last week when he weighed in on the arrest of his friend, Harvard professor Henry Louis Gates, Jr., saying the Cambridge police acted stupidly. He lost the presumption that he is colorblind and embraces all races and both genders equally.

This colorblindness was, perhaps, the fondest hope of the American public when we elected President Obama to our highest office.  As the son of a white woman from Kansas and a black man from Kenya we hoped his election marked the ascent of a leader possessed of so much empathy, so much intelligence and such a desire to understand all perspectives and experiences that he could resonate with anyone’s needs and disenfranchise no one.

That hope has withered for many, and it will be difficult to resurrect.  The fact that President Obama remained in a church headed by a pastor (Reverend Wright) who denounced white people, together with the fact that the First Lady says she felt no pride in our country until very recently, together with the fact that President Obama nominated a woman to the Supreme Court who slurred white judges as inferior, together with the President’s recent unwarranted slur of a white police sergeant as stupid seems to reveal deep-seated anger in him and constitutes a psychological pattern of insensitivity to the feelings of Caucasians.  He is a President who now (and hopefully only temporarily) seems the least colorblind of my lifetime, a terrible irony and tragedy I certainly didn’t imagine transpiring when he announced his candidacy.

The emotions some white people are sharing with me seem to parallel the feelings that African Americans may have struggled with in the past.  They tell me that they fear President Obama resents them, but won’t say so plainly, that he considers them “less than” others, maybe even demonic (like Reverend Wright does), but won’t admit it.  This gives them, and it gives me, a sliver of insight into how painful it must have been for disenfranchised minorities for decades in this country.  But the price of that slim window on the feelings of others has been high, indeed.  For the millions of white Americans who now better understand what it feels like to doubt that the President of the United States is their President, too, our heightened empathy comes with deep sadness and not a little anxiety.

President Obama doesn’t seem to understand the full depth of what has transpired.  It can’t be glossed over with the words he shared after the Crowley fiasco: 

“This has been ratcheting up, and I obviously helped to contribute ratcheting it up.  I want to make clear that in my choice of words, I think I unfortunately gave an impression that I was maligning the Cambridge Police Department and Sgt. Crowley specifically.  And I could’ve calibrated those words differently.”

He then invited Crowley over to the White House for a beer with Professor Gates.

What we needed, as white Americans, for all Americans, was a moment less about political caution and false camaraderie and more about self-revelation.  I kept thinking, as I listened to President Obama, of how short his statement fell from the words of another great African American politician, Jesse Jackson.  During the 1984 Presidential campaign, when Jackson sought the Democratic nomination, he referred to New York City as Hymietown, a slur against Jews.  I remember him taking the podium at the Democratic Convention and apologizing.  It was 25 years ago, and I was just 22-years-old, so forgive me if I have forgotten some of the words.  Most of them are seared into my memory—these two-and-a-half decades later:

“If I have offended anyone, or renewed old fears, I am deeply sorry.  Charge it to my head and not my heart.  I am an imperfect servant.  God is not yet finished with me.”

That was plenty good enough for me.  I didn’t believe Jackson could fake a statement like that.  And I never questioned the man’s heart again. 

President Obama, we need that kind of eloquence and honesty right now.  We need you to do that kind of soul-searching and let us in on the result.

As President Obama tries to remake the American health care system, the gutting of psychiatry by insurance company policies and other administrative forces is a good lesson in what to avoid. 

The endless red tape inherent in dealing with many insurers and the loss of professional autonomy to insurance company “reviewers,” has led many of the best and brightest psychiatrists and psychologists to accept no insurance reimbursement at all.  Psychiatrists have, if you will, acted out Atlas Shrugged, Ayn Rand’s cautionary tale of what can happen when institutions throttle individuals.  They’ve walked away and taken their gifts as healers with them.  In fact, when I refer patients to other mental health care professionals, it’s very challenging for me to find clinicians I consider in the top echelons of my field who will accept third party reimbursement of any kind.  A brain drain has siphoned off access to some of the wisest counsel available in psychiatry, except for those willing to pay cash, and I believe the same could happen (or greatly accelerate where it already is happening) in other medical specialties.

The influence of insurance company policies has also led to the public being served by professionals from allied health fields, such as clinical nurse specialists.  The need or desire for these companies to save money, which will only be accelerated by the current Obama plan, means social workers and nurses are the preferred providers of psychotherapy and medication evaluations to those battling depression and schizophrenia and bipolar disorder.  This phenomenon could find its reflection in the firm ground of internal medicine and endocrinology and obstetrics and other specialties yielding to intellectual quicksand, in which the knowledge and skills of physicians often disappear from the landscape entirely.

There’s nothing inherently wrong with getting your health care from physician assistants and nurses.  But these folks didn’t go to medical school, and didn’t complete residencies, and if I were confronting a serious condition I’d want to be treated by people who had.  I’d pay for it out of my own pocket.  And my guess is that we’ll end up having to.

Oh, one more thing:  Not only did many psychiatrists walk out on the system, lots of the ones who stayed let their practices be shaped by insurance company reimbursement policies that pay them more to prescribe medications than to talk to people.  So there are a whole bevy of shrinks who’ll see you for ten minutes once a month and just write you a prescription.  It actually pays pretty well, even if it leaves them out of seventy percent of what can restore patients—effective, expert psychotherapy.  That medical art is in danger of extinction.

See, Obama’s eight principles for overhauling health care address economics, access, prevention, safety and cost.  They don’t address how to preserve the core of the world’s most successful, powerful, inventive health care system ever:  the contributions and creativity and commitment of America’s physicians.