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class="py-3 text-gray-600 md:flex flex-col md:justify-between"><div class="flex flex-col xs:flex-row"><p class="mr-1 self-start">Author(s):</p><div class="flex flex-col xs:flex-row mb-3 md:mb-0"><div class="flex flex-wrap"><span class="text-md mr-2"><a class="text-author text-gray-500 hover:text-primary underline hover:no-underline decoration-gray-400" href="/authors/john-j-miller-md">John J. Miller, MD</a></span></div></div></div><div class="max-w-full"><div class="flex flex-wrap sm:flex-nowrap items-center w-fit my-2"></div><div class="w-full flex flex-col sm:flex-row justify-between mt-2"><div class="block md:hidden "><div class="mt-2 flex items-center max-w-fit"><button title="A Tribute to Black History Month" aria-label="facebook" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#3b5998"></circle><path d="M34.1,47V33.3h4.6l0.7-5.3h-5.3v-3.4c0-1.5,0.4-2.6,2.6-2.6l2.8,0v-4.8c-0.5-0.1-2.2-0.2-4.1-0.2 c-4.1,0-6.9,2.5-6.9,7V28H24v5.3h4.6V47H34.1z" fill="white"></path></svg></button><button aria-label="twitter" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg fill="#DC7633" xmlns="http://www.w3.org/2000/svg" width="32" zoomAndPan="magnify" viewBox="0 0 375 374.9999" height="32" preserveAspectRatio="xMidYMid meet" version="1.0"><defs><path d="M 7.09375 7.09375 L 367.84375 7.09375 L 367.84375 367.84375 L 7.09375 367.84375 Z M 7.09375 7.09375 " fill="#000000"></path></defs><g><path d="M 187.46875 7.09375 C 87.851562 7.09375 7.09375 87.851562 7.09375 187.46875 C 7.09375 287.085938 87.851562 367.84375 187.46875 367.84375 C 287.085938 367.84375 367.84375 287.085938 367.84375 187.46875 C 367.84375 87.851562 287.085938 7.09375 187.46875 7.09375 " fill-opacity="1" fill-rule="nonzero" fill="#000000"></path></g><g transform="translate(85, 75)"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" version="1.1" height="215" width="215"><path d="M18.244 2.25h3.308l-7.227 8.26 8.502 11.24H16.17l-5.214-6.817L4.99 21.75H1.68l7.73-8.835L1.254 2.25H8.08l4.713 6.231zm-1.161 17.52h1.833L7.084 4.126H5.117z" fill="#ffffff"></path></svg> </g></svg></button><button aria-label="linkedin" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#007fb1"></circle><path d="M20.4,44h5.4V26.6h-5.4V44z M23.1,18c-1.7,0-3.1,1.4-3.1,3.1c0,1.7,1.4,3.1,3.1,3.1 c1.7,0,3.1-1.4,3.1-3.1C26.2,19.4,24.8,18,23.1,18z M39.5,26.2c-2.6,0-4.4,1.4-5.1,2.8h-0.1v-2.4h-5.2V44h5.4v-8.6 c0-2.3,0.4-4.5,3.2-4.5c2.8,0,2.8,2.6,2.8,4.6V44H46v-9.5C46,29.8,45,26.2,39.5,26.2z" fill="white"></path></svg></button><button title="A Tribute to Black History Month" aria-label="pinterest" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#cb2128"></circle><path d="M32,16c-8.8,0-16,7.2-16,16c0,6.6,3.9,12.2,9.6,14.7c0-1.1,0-2.5,0.3-3.7 c0.3-1.3,2.1-8.7,2.1-8.7s-0.5-1-0.5-2.5c0-2.4,1.4-4.1,3.1-4.1c1.5,0,2.2,1.1,2.2,2.4c0,1.5-0.9,3.7-1.4,5.7 c-0.4,1.7,0.9,3.1,2.5,3.1c3,0,5.1-3.9,5.1-8.5c0-3.5-2.4-6.1-6.7-6.1c-4.9,0-7.9,3.6-7.9,7.7c0,1.4,0.4,2.4,1.1,3.1 c0.3,0.3,0.3,0.5,0.2,0.9c-0.1,0.3-0.3,1-0.3,1.3c-0.1,0.4-0.4,0.6-0.8,0.4c-2.2-0.9-3.3-3.4-3.3-6.1c0-4.5,3.8-10,11.4-10 c6.1,0,10.1,4.4,10.1,9.2c0,6.3-3.5,11-8.6,11c-1.7,0-3.4-0.9-3.9-2c0,0-0.9,3.7-1.1,4.4c-0.3,1.2-1,2.5-1.6,3.4 c1.4,0.4,3,0.7,4.5,0.7c8.8,0,16-7.2,16-16C48,23.2,40.8,16,32,16z" fill="white"></path></svg></button><button aria-label="email" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#7f7f7f"></circle><path d="M17,22v20h30V22H17z M41.1,25L32,32.1L22.9,25H41.1z M20,39V26.6l12,9.3l12-9.3V39H20z" fill="white"></path></svg></button><a class="print-wrap flex justify-center items-center cursor-pointer"><svg id="print" xmlns="http://www.w3.org/2000/svg" width="24" height="24" fill="currentColor" class="print bi bi-printer" viewBox="0 0 16 16"> <path d="M2.5 8a.5.5 0 1 0 0-1 .5.5 0 0 0 0 1z"></path> <path d="M5 1a2 2 0 0 0-2 2v2H2a2 2 0 0 0-2 2v3a2 2 0 0 0 2 2h1v1a2 2 0 0 0 2 2h6a2 2 0 0 0 2-2v-1h1a2 2 0 0 0 2-2V7a2 2 0 0 0-2-2h-1V3a2 2 0 0 0-2-2H5zM4 3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1v2H4V3zm1 5a2 2 0 0 0-2 2v1H2a1 1 0 0 1-1-1V7a1 1 0 0 1 1-1h12a1 1 0 0 1 1 1v3a1 1 0 0 1-1 1h-1v-1a2 2 0 0 0-2-2H5zm7 2v3a1 1 0 0 1-1 1H5a1 1 0 0 1-1-1v-3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1z"></path></svg></a></div><style> .print-wrap { width: 32px; height: 32px; background: #7F7F7F; border-radius: 100%; } .print { background: #7F7F7F; color: white; padding: 2px; border-radius: 100%; } </style></div></div></div></div><div class=" lg:w-full flex flex-col lg:flex-row lg:items-center lg:justify-end"></div><p class="py-2 mb-2 text-sm italic text-gray-600">As February comes to a close, we reflect on this month's contributions.</p><div class="py-2"><div class="blockText_blockContent__TbCXh"><div class="flex justify-center"><div style="width:30%;float:;max-width:525px;margin:0 auto 1rem;clear:both;cursor:pointer" class=" figure"><div class="flex-none relative text-center"><span style="box-sizing:border-box;display:inline-block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative;max-width:100%"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;max-width:100%"><img style="display:block;max-width:100%;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0" alt="" aria-hidden="true" src="data:image/svg+xml,%3csvg%20xmlns=%27http://www.w3.org/2000/svg%27%20version=%271.1%27%20width=%271000%27%20height=%27451%27/%3e"/></span><img alt="freshidea/AdobeStock" title="freshidea/AdobeStock" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain"/><noscript><img alt="freshidea/AdobeStock" title="freshidea/AdobeStock" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F70e72f0d408fe507c41d941321da1cecfd3045fd-1000x451.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1x, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F70e72f0d408fe507c41d941321da1cecfd3045fd-1000x451.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2x" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F70e72f0d408fe507c41d941321da1cecfd3045fd-1000x451.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain" loading="lazy"/></noscript></span></div><div id="image-caption" class="text-gray-500 italic"><div class="blockText_blockContent__TbCXh"><p class="pb-2">freshidea/AdobeStock</p></div></div><div class="top-[-100%] block w-[1px] transition-opacity duration-500 ease-in-out opacity-0 overflow-hidden"><img class="m-auto absolute inset-0 max-w-[0%] max-h-[0%] border-[3px] border-solid border-white shadow-[0px_0px_8px_rgba(0,0,0,0.3)] box-border transition ease-in-out duration-500" src="https://cdn.sanity.io/images/0vv8moc6/psychtimes/70e72f0d408fe507c41d941321da1cecfd3045fd-1000x451.jpg?fit=crop&auto=format"/></div></div><style> #image-caption p{ font-size: 12px; max-width: 525px; margin: 0 auto; text-align: center; } </style></div><p class="pb-2"><strong>BLACK HISTORY MONTH</strong></p><p class="pb-2">On behalf of <em>Psychiatric Times</em><sup class="text-inherit">TM</sup>, I would like to thank each and every one of our contributors for making the Black History Month series impactful, current, and relevant to advancing the conversation about equality in psychiatry and the world. </p><p class="pb-2">Special thanks to Frank Clark, MD, Diversity & Inclusion section editor, for marshalling the project. Please enjoy each of this month’s pieces.</p><p class="pb-2"><strong>Series editor, Frank Clark, MD: </strong><a target="_blank" href="https://www.psychiatrictimes.com/view/mentorship-salute-windy-city-educator">Mentorship: Salute to a Windy City Educator</a></p><p class="pb-2"><strong>Balkozar Adam, MD, Rameshwari V. Tumuluru, MD, and Sarah H. Arshad, MD</strong>: <a target="_blank" href="https://www.psychiatrictimes.com/view/why-psychiatry-training-must-include-discussions-structural-racism">Why Psychiatry Training Must Include Discussions on Structural Racism</a></p><p class="pb-2"><strong>Rakin Hoq, MD, and Balkozar S. Adam, MD</strong>: <a target="_blank" href="https://www.psychiatrictimes.com/view/black-americans-distrust-covid-vaccine">Black Americans’ Distrust of the COVID-19 Vaccine</a></p><p class="pb-2"><strong>Rahn Bailey, MD, and Amit Grover, MBBS: </strong><a target="_blank" href="https://www.psychiatrictimes.com/view/why-black-history-month-important-psychiatry">Why Is Black History Month Important to Psychiatry?</a></p><p class="pb-2"><strong>Jessica Isom, MD, MPH:</strong> <a target="_blank" href="https://www.psychiatrictimes.com/view/10-antiracist-habits-psychiatrists">10 Antiracist Habits for Psychiatrists</a></p><p class="pb-2"><strong>Jonathan S. Jones, PhD:</strong> <a target="_blank" href="https://www.psychiatrictimes.com/view/race-opioids-lessons-civil-war-era-opioid-addiction-crisis">Race and Opioids: Lessons From the Civil War-Era Opioid Addiction Crisis</a></p><p class="pb-2"><strong>H. Steven Moffic, MD, and Rahn Bailey, MD: </strong><a target="_blank" href="https://www.psychiatrictimes.com/view/we-had-hammer.">If I Had a Hammer: Advancing the Conversation in Psychiatry and Racism</a></p><p class="pb-2"><strong>H. Steven Moffic, MD:</strong> <a target="_blank" href="https://www.psychiatrictimes.com/view/purcell-pearson-young-black-man-who-dreamt-becoming-psychiatrist">Purcell Pearson: A Young Black Man Who Dreamt of Becoming a Psychiatrist</a></p><p class="pb-2"><strong>Leah Kuntz: </strong><a target="_blank" href="https://www.psychiatrictimes.com/view/tribute-black-history-month">7 Black Physicians That Made History in the Mental Health Field</a></p><p class="pb-2">Special thanks to <strong>Greg Eghigian, PhD</strong>, History of Psychiatry section editor for <em>Psychiatric Times</em><sup class="text-inherit">TM</sup>, for submitting on behalf of Dr Jones.</p><p class="pb-2"><strong>Dr Miller</strong><em> is medical director, Brain Health, Exeter, NH; editor in chief,</em> Psychiatric Times<em><sup class="text-inherit">TM</sup>; staff psychiatrist, Seacoast Mental Health Center, Exeter, NH; consulting psychiatrist, Exeter Hospital, Exeter, NH; consulting psychiatrist, Insight Meditation Society, Barre, MA.</em></p></div></div><div class="flex items-center lg:w-3/4 mb-4 pb-12"></div><div class="jsx-19ede9f0a5a45918 py-4 relative bg-primary md:px-8 -ml-6 xs:ml-0 w-screen xs:w-auto"><div class="jsx-19ede9f0a5a45918 px-4 sm:px-0"><div class="flex justify-between items-center py-1 space-x-4 border-0 select-none sm:border-b border-secondary"><div class="text-3xl text-white text-lg sm:text-3xl">Related Videos</div></div></div><div style="scroll-snap-type:none" class="jsx-19ede9f0a5a45918 flex items-start overflow-x-auto space-x-4 py-4 relative mx-auto w-full pl-4"><a id="" class="w-[200px] h-fit space-y-3 flex-none select-none no-underline" style="scroll-snap-align:center;text-decoration:none" href="/view/an-evolving-cultural-transformation-in-our-societal-and-psychiatric-leadership"><div class="w-full shadow-md shadow-gray-800 overflow-hidden relative bg-white aspect-video"><span 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Deibler, PsyD, ABPP</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/renae-reinardy-psyd">Renae Reinardy, PsyD</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/gender-culture-and-social-constructs-in-body-focused-repetitive-behaviors?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent"></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 gap-x-4"><a class="jsx-ad50481d5ee26850" href="/view/the-week-in-review-june-10-14?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/psychtimes/51d3cd8b64698f18bbaa58a4dd6d2804957c12c0-1500x824.jpg?fit=crop&auto=format" alt="Here are highlights from the week in Psychiatric Times." width="288" class="jsx-ad50481d5ee26850 lg:w-[110px] lg:h-[100px] xl:w-[135px] xl:h-[125px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full xl:w-[70%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">June 15th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/the-week-in-review-june-10-14?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent">The Week in Review: June 10-14</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/erin-o-brien">Erin O'Brien</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/the-week-in-review-june-10-14?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent"></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="pb-24"></div></div><script type="application/ld+json">{"@context":"https://schema.org","@type":"NewsArticle","headline":"A Tribute to Black History Month","datePublished":"2021-02-26T17:00:00.000Z","dateModified":"2021-03-02T15:22:49Z","inLanguage":"en-US","image":"https://cdn.sanity.io/images/0vv8moc6/psychtimes/70e72f0d408fe507c41d941321da1cecfd3045fd-1000x451.jpg?fit=crop&auto=format","mainEntityOfPage":{"@type":"WebPage","@id":"https://www.psychiatrictimes.com/view/tribute-black-history-month"},"publisher":{"@type":"Organization","name":"Psychiatric Times","logo":{"@type":"ImageObject","url":"https://www.psychiatrictimes.com/PsychiatricTimesLogo.png"}},"keywords":"black history month,health,equality,diversity,mental health,health,psychiatry","articleBody":"\n\nBLACK HISTORY MONTH\n\nOn behalf of Psychiatric TimesTM, I would like to thank each and every one of our contributors for making the Black History Month series impactful, current, and relevant to advancing the conversation about equality in psychiatry and the world. \n\nSpecial thanks to Frank Clark, MD, Diversity & Inclusion section editor, for marshalling the project. Please enjoy each of this month’s pieces.\n\nSeries editor, Frank Clark, MD: Mentorship: Salute to a Windy City Educator\n\nBalkozar Adam, MD, Rameshwari V. Tumuluru, MD, and Sarah H. Arshad, MD: Why Psychiatry Training Must Include Discussions on Structural Racism\n\nRakin Hoq, MD, and Balkozar S. Adam, MD: Black Americans’ Distrust of the COVID-19 Vaccine\n\nRahn Bailey, MD, and Amit Grover, MBBS: Why Is Black History Month Important to Psychiatry?\n\nJessica Isom, MD, MPH: 10 Antiracist Habits for Psychiatrists\n\nJonathan S. Jones, PhD: Race and Opioids: Lessons From the Civil War-Era Opioid Addiction Crisis\n\nH. Steven Moffic, MD, and Rahn Bailey, MD: If I Had a Hammer: Advancing the Conversation in Psychiatry and Racism\n\nH. Steven Moffic, MD: Purcell Pearson: A Young Black Man Who Dreamt of Becoming a Psychiatrist\n\nLeah Kuntz: 7 Black Physicians That Made History in the Mental Health Field\n\nSpecial thanks to Greg Eghigian, PhD, History of Psychiatry section editor for Psychiatric TimesTM, for submitting on behalf of Dr Jones.\n\nDr Miller is medical director, Brain Health, Exeter, NH; editor in chief, Psychiatric TimesTM; staff psychiatrist, Seacoast Mental Health Center, Exeter, NH; consulting psychiatrist, Exeter Hospital, Exeter, NH; consulting psychiatrist, Insight Meditation Society, Barre, MA.","description":"As February comes to a close, we reflect on this month's contributions.","author":[{"@type":"Person","name":"John J. 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Some of these films have garnered enduring critical praise, establishing their place in film canon as “good,” “great,” or even “classic.” Films such as "},{"_type":"span","marks":["em"],"text":"M","_key":"7b32ca59f7111"},{"_key":"7b32ca59f7112","_type":"span","marks":[],"text":" (1932), "},{"_type":"span","marks":["em"],"text":"One Flew Over the Cuckoo’s Nest","_key":"7b32ca59f7113"},{"_type":"span","marks":[],"text":" (1975), and ","_key":"7b32ca59f7114"},{"_key":"7b32ca59f7115","_type":"span","marks":["em"],"text":"Black Swan"},{"_type":"span","marks":[],"text":" (2010) attempt to engage with social, cultural, and medical discourses around madness. Such films provide valuable opportunities for psychiatrists to engage with the public and each other regarding relevant psychiatric themes. But what of critical and commercial failures—in other words, bad films? For psychiatrists, can poorly made films (even ones without mental health as a central narrative element) contain themes worthy of analysis? We would suggest that in some ways they might be equally useful, not least because bad movies will frequently offer insight into the everyday, popular, quotidian cultural discourses around mental health in a way that is unselfconscious and thereby extremely enlightening.","_key":"7b32ca59f7116"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"","_key":"70d7de1b7d740"}],"_type":"block","style":"normal","_key":"10631b58e9b9","markDefs":[]},{"style":"normal","_key":"fe6d1bb301eb","markDefs":[],"children":[{"text":"As perhaps the Platonic ideal of a bad film, what could we say about ","_key":"ba750f45d44f0","_type":"span","marks":[]},{"text":"The Room ","_key":"ba750f45d44f1","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":"(2003)?","_key":"ba750f45d44f2"},{"_type":"span","marks":["superscript"],"text":"1","_key":"9e0c5c1eb8db"},{"_type":"span","marks":[],"text":" Written, directed, produced by, and starring Tommy Wiseau, ","_key":"d9a0cfdaf615"},{"_type":"span","marks":["em"],"text":"The Room","_key":"ba750f45d44f3"},{"marks":[],"text":" is considered by many to be the “worst movie ever made.”","_key":"ba750f45d44f4","_type":"span"},{"_type":"span","marks":["superscript"],"text":"2","_key":"c8dfceb397ca"},{"_type":"span","marks":[],"text":" Despite (or rather, because of) the film’s terrible reputation, it has taken on cult status, giving it a persistent cultural footprint. ","_key":"cb0d03fc97bf"},{"_type":"span","marks":["em"],"text":"The Room","_key":"ba750f45d44f5"},{"_type":"span","marks":[],"text":" is regularly screened in theaters around the world, a dramatization of the making of the film (","_key":"ba750f45d44f6"},{"marks":["em"],"text":"The Disaster Artist","_key":"ba750f45d44f7","_type":"span"},{"_type":"span","marks":[],"text":") won a Golden Globe in 2017, and a remake of ","_key":"ba750f45d44f8"},{"marks":["em"],"text":"The Room","_key":"ba750f45d44f9","_type":"span"},{"_type":"span","marks":[],"text":" was filmed in 2023 with release date pending.","_key":"ba750f45d44f10"},{"text":"3","_key":"305bf5cd6ead","_type":"span","marks":["superscript"]},{"text":" While not narratively focused on psychiatry, ","_key":"fc1bcc1fe8e8","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"The Room","_key":"ba750f45d44f11"},{"_type":"span","marks":[],"text":" peripherally engages with topics related to mental illness. This article examines 4 psychiatric themes in ","_key":"ba750f45d44f12"},{"text":"The Room","_key":"ba750f45d44f13","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":": (1) psychiatric treatment, (2) psychopathology, (3) substance use disorders, and (4) suicide. We have selected 4 characters from the film that respectively illustrate each of these themes: Peter (Kyle Vogt), Lisa (Juliette Danielle), Mark (Greg Sestero), and Johnny (Tommy Wiseau).","_key":"ba750f45d44f14"}],"_type":"block"},{"style":"normal","_key":"226bf4e6a3a9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"51786f91ae5b0"}],"_type":"block"},{"_type":"block","style":"normal","_key":"3081c134c015","markDefs":[],"children":[{"_key":"0a3771684dfb0","_type":"span","marks":["strong"],"text":"Psychiatric Treatment: Peter"}]},{"_type":"block","style":"normal","_key":"0f2652c98d6f","markDefs":[],"children":[{"_key":"4d2c2ae636080","_type":"span","marks":["em"],"text":"The Room "},{"text":"has a simple story and a small cast: Johnny is engaged to Lisa, but when Lisa has an affair with Johnny’s best friend Mark, everyone’s lives are thrown into chaos. Partway through ","_key":"4d2c2ae636081","_type":"span","marks":[]},{"_key":"4d2c2ae636082","_type":"span","marks":["em"],"text":"The Room"},{"_key":"4d2c2ae636083","_type":"span","marks":[],"text":", we are introduced to another of Johnny’s friends: Peter. During their first on-screen conversation, Johnny seeks Peter’s help in navigating Lisa’s infidelity: “You’re a psychologist, do you have some advice?” Later in that same scene, Johnny derides Peter, saying, “you always play psychologist with us.” Johnny’s statements are contradictory: initially he seeks Peter’s help as a psychologist, but then he calls Peter’s professional legitimacy into question, suggesting he only “plays” psychologist. Johnny’s comments illustrate the lack of respect mental health professionals experience in the real world. A 2010 study showed that many in the general public underestimate the education of psychiatrists and label them as “odd,” mentally ill, or abusive."},{"_type":"span","marks":["superscript"],"text":"4","_key":"e192bff74915"},{"_type":"span","marks":[],"text":" Even among other health professionals, psychiatrists may be perceived as “not real doctors.”","_key":"a79a71faaf1a"},{"marks":["superscript"],"text":"4","_key":"8dd3962a5658","_type":"span"},{"text":" These facts demonstrate a persistent stigma that surrounds mental health professions.","_key":"c2660bb1cdcc","_type":"span","marks":[]}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"45e9225f15fd0"}],"_type":"block","style":"normal","_key":"ee3d5333ddc0"},{"style":"normal","_key":"ce53bf15ff46","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Johnny asks Peter for “some advice,” phrasing that is echoed by Peter in a later scene with Mark (“You want my advice?”). Identifying Peter as a psychologist and then framing his role as advice giver suggests that psychotherapy is equivalent to advice-dispensing. This is a misunderstanding of the psychotherapeutic process: instead of depicting therapy as a shared work between therapist and client, the imagined advice-dispensing therapist simply tells the client what to do. Although giving advice may constitute a (typically small) part of psychotherapy, an overreliance on advice can actually hinder client collaboration.","_key":"36bf49e29b3d0"},{"_key":"5518fa775b18","_type":"span","marks":["superscript"],"text":"5"},{"_type":"span","marks":[],"text":" Unfortunately, ","_key":"622fbdf78567"},{"_key":"36bf49e29b3d1","_type":"span","marks":["em"],"text":"The Room"},{"marks":[],"text":" does not appear to understand that a therapist could do more than give advice, as much of Peter’s dialogue falls into the trap of cliches:","_key":"36bf49e29b3d2","_type":"span"}],"_type":"block"},{"_key":"9406318c9fe0","markDefs":[],"children":[{"_key":"8a9a41fbdfbb0","_type":"span","marks":[],"text":"“The unexpected can happen. When it does, you’ve just got to deal with it.”"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"“You should tell her about your feelings.”","_key":"08ebe8a572a00"}],"_type":"block","style":"normal","_key":"d0d0c5c2b0dc"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"“People are people.”","_key":"24a5c3c806110"}],"_type":"block","style":"normal","_key":"69c34b4a9cce"},{"_key":"5901c175d93e","markDefs":[],"children":[{"marks":[],"text":"“Sometimes life can get complicated, and you’ve got to be responsible.”","_key":"17aaf65b39ac0","_type":"span"}],"_type":"block","style":"normal"},{"style":"normal","_key":"e5bc5a7deda9","markDefs":[],"children":[{"marks":[],"text":"","_key":"a38f3f68f7340","_type":"span"}],"_type":"block"},{"style":"normal","_key":"5e790afa1d90","markDefs":[],"children":[{"_type":"span","marks":[],"text":"While Peter is never depicted as treating Johnny, Lisa, or Mark in a formal clinical setting, some of their interactions suggest that he is speaking from the position of psychotherapist. Peter first appears in Johnny’s den that, with its dark woods, bookshelf, and fireplace, evokes television and movie stereotypes of a traditional therapist’s office. Peter speaks with his friends using language commonly associated with the opening statements of a therapy appointment: “Tell me about your problems, Johnny,” and later, “Let’s just talk about your problem.” Peter behaving as friend-as-therapist is also shown by his use of clinical terminology, labelling Lisa as a “sociopath” and Mark as “depressed.” If Peter is in fact functioning as therapist for his friends, this illustrates a violation of generally accepted ethical principles. In mental health professions, trainees are instructed to avoid treating close relations because their objectivity in treatment can be impaired by the closeness of the relationship.","_key":"f0414e14b5520"},{"marks":["superscript"],"text":"6","_key":"727299952e51","_type":"span"},{"_type":"span","marks":[],"text":" There may be some flexibility with these boundaries in rural communities with limited access to mental health resources, but Johnny and Peter reside in San Francisco, a large city with abundant health care services.","_key":"02a41552d943"},{"_type":"span","marks":["superscript"],"text":"7","_key":"ac68329a14f8"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e7e35d5e465d0"}],"_type":"block","style":"normal","_key":"70c70bc5f215"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Psychopathology: Lisa","_key":"044d299db9660"}],"_type":"block","style":"normal","_key":"053d12a5af79"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"There are several characters in ","_key":"5ffe70abdd840"},{"_key":"5ffe70abdd841","_type":"span","marks":["em"],"text":"The Room"},{"_type":"span","marks":[],"text":" whose behavior may illustrate psychopathology. Does Denny (Philip Haldiman), the man-child who appears to rely on Johnny and Lisa as parent figures, have Peter Pan syndrome? Does Mike (Mike Holmes), who engages in a sexual liaison with Michelle (Robyn Paris) in the middle of Johnny’s unlocked front room, have a paraphilic condition such as exhibitionistic disorder? Or perhaps Mike’s cataplectic loss of muscle tone after laughing and being lightly tapped by Mark with a football is evidence of narcolepsy? These characters are not explicitly pathologized within the narrative of the film: Denny’s childlike disposition gives Johnny a fatherly role, and Mike’s antics are comic relief. It is Lisa whose troublesome behavior is most worthy of diagnostic consideration. As mentioned previously, at one point Peter the psychologist dubs her a “sociopath—she only cares about herself, she can’t love anyone!”","_key":"5ffe70abdd842"}],"_type":"block","style":"normal","_key":"09337f97dbbb"},{"children":[{"_type":"span","marks":[],"text":"","_key":"c8a646a3a8890"}],"_type":"block","style":"normal","_key":"68d0d238c276","markDefs":[]},{"markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F567bbc1e3f380ac63c806f2414a4c9ecc3aa4b5c-1146x1352.png%3Ffit%3Dcrop%26auto%3Dformat\u0026w=3840\u0026q=75","_key":"366bf3ab5aec"}],"children":[{"_type":"span","marks":[],"text":"Sociopathy is more commonly referred to in modern diagnostic terminology as antisocial personality disorder. To understand whether Lisa’s behavior in the film supports a diagnosis of antisocial personality disorder, its diagnostic criteria are summarized in the ","_key":"6029b15a5b360"},{"text":"Table","_key":"6029b15a5b361","_type":"span","marks":["strong","366bf3ab5aec"]},{"_type":"span","marks":[],"text":".","_key":"6029b15a5b362"},{"_type":"span","marks":["superscript"],"text":"8","_key":"3f9ba15a5ead"}],"_type":"block","style":"normal","_key":"35289e94f445"},{"disableLightBox":true,"_type":"figure","alignment":"right","_key":"84f602c74037","asset":{"_ref":"image-567bbc1e3f380ac63c806f2414a4c9ecc3aa4b5c-1146x1352-png","_type":"reference"},"alt":"Table. Cluster B Personality Disorders Criteria","widthP":60,"blank":true,"disableTextWrap":false,"imgcaption":[{"style":"normal","_key":"6575c885f245","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Table. ","_key":"d0d690ec3f390"},{"_type":"span","marks":[],"text":"Cluster B Personality Disorders Criteria","_key":"923476a5222f"},{"_type":"span","marks":["superscript"],"text":"8","_key":"674cd1638559"}],"_type":"block"}]},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"ab331c9f868b0","_type":"span"}],"_type":"block","style":"normal","_key":"a62baa5d0fda"},{"_key":"563b69179b4f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Lisa is deceitful throughout ","_key":"9dedfc4a809e0"},{"_type":"span","marks":["em"],"text":"The Room","_key":"9dedfc4a809e1"},{"_key":"9dedfc4a809e2","_type":"span","marks":[],"text":": she misleads Johnny about her feelings, falsely tells Michelle that Johnny hit her, hides her ongoing affair with Mark, and lies to Johnny about her pregnancy. The intent of her deceptions appears to be for personal pleasure, as Lisa tells Michelle at one point: “I want it all… You have to take as much as you can. You have to live, live, live!” She seems impulsive in her decision-making, not thinking through the consequences of her deceptions. When Michelle points out that there is “no simple solution” to Lisa’s web of lies, Lisa responds with a blasé, “don’t worry!” Lisa demonstrates an impaired capacity for empathy and a lack of remorse. Michelle confronts Lisa about the pain that her actions will cause Johnny, but Lisa refuses to acknowledge that she is causing any harm. Michelle asks Lisa point blank, “You don’t feel guilty about this at all?” to which Lisa replies, “No.” At the end of the movie, Lisa briefly appears remorseful after Johnny’s suicide, sobbing uncontrollably for several minutes. However, this remorse is undercut by her self-serving declaration to Mark: “We’re free to be together.” Assembling the evidence, Lisa does appear to meet the required 3 symptoms of criterion A for antisocial personality disorder."}],"_type":"block","style":"normal"},{"style":"normal","_key":"6b4baba9144d","markDefs":[],"children":[{"text":"","_key":"aace9495d6ca0","_type":"span","marks":[]}],"_type":"block"},{"style":"normal","_key":"b2640feaa812","markDefs":[{"_key":"867c5c014d6c","nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F567bbc1e3f380ac63c806f2414a4c9ecc3aa4b5c-1146x1352.png%3Ffit%3Dcrop%26auto%3Dformat\u0026w=3840\u0026q=75"}],"children":[{"_type":"span","marks":[],"text":"Even with these signs of sociopathy, other Cluster B personality disorders are part of the differential diagnosis for Lisa’s behavior (","_key":"221d8632b9f80"},{"_type":"span","marks":["strong","867c5c014d6c"],"text":"Table","_key":"221d8632b9f81"},{"_type":"span","marks":[],"text":").","_key":"221d8632b9f82"},{"marks":["superscript"],"text":"8","_key":"3fba769ff0d5","_type":"span"},{"_type":"span","marks":[],"text":" Borderline personality disorder is a possibility. Lisa’s love triangle could be evidence of “a pattern of unstable and intense interpersonal relationships.”","_key":"ca95093fb735"},{"_type":"span","marks":["superscript"],"text":"8","_key":"eda6006c8731"},{"_type":"span","marks":[],"text":" She is impulsive. Her plea to Mark after Johnny’s suicide, “I’ve lost him, but I still have you, right? Right?” may show her frantic efforts to avoid abandonment. Histrionic personality disorder is another consideration. Lisa appears to enjoy being the center of attention, such as at Johnny’s birthday party where an unnamed male partygoer comments to his date, “Lisa looks hot tonight.” Her style of speech is lacking in detail, frequently saying “don’t worry about it” and “I don’t want to talk about it.” Her interactions with Mark are sexually seductive. Early in the film Lisa appears to consider her relationship with Mark to be more intimate than it is. When she addresses Mark as “lover boy,” he replies with confusion: “What are you doing this for?”","_key":"a658e4e6dc76"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"","_key":"19e43a3b05210"}],"_type":"block","style":"normal","_key":"8b38b4b0344f","markDefs":[]},{"_key":"b44b3d6f8063","markDefs":[],"children":[{"_type":"span","marks":[],"text":"It is worth noting that as a fictional character, Lisa is a representation of the ideas of her creator/author, Tommy Wiseau. Wiseau may be saying things through Lisa that express his own beliefs about women—let’s not forget that Lisa’s mother is also characterized as a ruthless and cold-hearted gold-digger—even in ways of which he is unaware. However, rather than attempting to dissect Wiseau’s mind, we are limiting ourselves to an examination of the character as presented in the text of the film. Lisa’s portrayal in","_key":"050a114a3ef70"},{"_type":"span","marks":["em"],"text":" The Room","_key":"050a114a3ef71"},{"marks":[],"text":" is consistent with a cluster B personality disorder, most likely antisocial personality disorder given her lack of empathy.","_key":"050a114a3ef72","_type":"span"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"a3e725335042","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"bd5dd986e6e20"}]},{"markDefs":[],"children":[{"text":"Substance Use Disorder: Mark","_key":"5ccdd9844fe50","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"7b72d08aa324"},{"style":"normal","_key":"bd7b6e8cc93c","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/topics/addiction-suds-compulsive","_key":"350b3bc75334"}],"children":[{"text":"The subject of ","_key":"b2a0cccfd2130","_type":"span","marks":[]},{"_type":"span","marks":["350b3bc75334"],"text":"substance misuse","_key":"48f466a423a3"},{"_type":"span","marks":[],"text":" arises throughout the film. While alcohol is innocuously present in many depicted social interactions, there is a critical moment when Lisa, having convinced teetotaler Johnny to drink, falsely claims that he physically abused her while drunk. Alcohol’s function in this case is to illustrate Lisa’s manipulative behavior.","_key":"2e00b24ccc1c"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"","_key":"3c679d6d93570"}],"_type":"block","style":"normal","_key":"43d25406e1e5","markDefs":[]},{"_key":"af3acff5f0ae","markDefs":[],"children":[{"marks":[],"text":"Illicit drugs play a central role in 2 scenes. In the first, Denny is saved from a violent drug dealer to whom he is financially indebted. In the second,Mark is smoking a joint when Peter joins him on the roof terrace. As the scene progresses, Mark exhibits signs of possible problem cannabis use. Research has shown that cannabis use is associated with disturbances in mood, reality testing, and cognition. Problem use can manifest with impairments in social relationships, vocational obligations, and risky behaviors.","_key":"450128c2107d0","_type":"span"},{"_type":"span","marks":["superscript"],"text":"9","_key":"66479a4a9c7b"},{"text":" Mark clearly does not see his cannabis use as problematic, as he states, “It’s good, bro.” However, Peter is worried: “You look depressed.” Mark admits that he fantasizes about escaping the consequences of his affair by “running” or dying by suicide. Peter expresses concern that cannabis is negatively impacting Mark’s mental state, describing cannabis as “crap,” and observing: “It’s no wonder you can’t think straight. It’s gonna screw with your head!” Mark’s impulse control is clearly impaired, as he briefly attempts to throw Peter off the rooftop before coming to his senses. ","_key":"b642e645d7fb","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"The Room ","_key":"450128c2107d1"},{"_type":"span","marks":[],"text":"was released in 2003, during a time when the risks of cannabis use were more recognized and potential medicinal uses were not widely accepted. As cannabis has been legalized across the United States, the pendulum of public opinion has swung dramatically in the direction of accepting cannabis both medicinally and recreationally with a corresponding reduction in the perceived risks of cannabis use.","_key":"450128c2107d2"},{"_type":"span","marks":["strikethrough","superscript"],"text":"10,11","_key":"f641ae0c3c76"},{"_type":"span","marks":[],"text":" Mark’s possible cannabis-induced mental disruptions illustrate Tommy Wiseau’s understanding of marijuana, grounded in a time when cannabis use was largely perceived as dangerous.","_key":"4e48337895e3"}],"_type":"block","style":"normal"},{"_key":"63aadc0ca360","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"069cd98d64010"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"Suicide: Johnny","_key":"4404e7ec59bc0"}],"_type":"block","style":"normal","_key":"4f694f57e979","markDefs":[]},{"_type":"block","style":"normal","_key":"845e7af74350","markDefs":[{"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/topics/suicide","_key":"c35a4a7c2d86","nofollow":true}],"children":[{"_type":"span","marks":[],"text":"The concluding scenes in ","_key":"c442e0c2f2a50"},{"text":"The Room","_key":"c442e0c2f2a51","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" center around Johnny’s ","_key":"c442e0c2f2a52"},{"text":"suicide","_key":"b2dd8afc41c5","_type":"span","marks":["c35a4a7c2d86"]},{"_type":"span","marks":[],"text":". After confirming that she and Mark have had an affair, Lisa informs Johnny she is leaving him. Johnny, in tears, shouts and breaks random objects in his home. As he sits on his bedroom floor in shambles, Johnny reaches over to a small, unlocked case and pulls out a handgun. “It’s over,” he states before placing the gun into his mouth and pulling the trigger. He is later found by Lisa, Mark, and Denny lying in a pool of blood.","_key":"834b621ea5bf"}]},{"children":[{"_type":"span","marks":[],"text":"","_key":"a97602390a6e0"}],"_type":"block","style":"normal","_key":"06fba745eb53","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Johnny’s death illustrates some important points related to suicide prevention. First, it correctly demonstrates the importance of firearm safety. Firearms in the home are a significant risk factor for death by suicide.","_key":"9b8d1d832f2f0"},{"_type":"span","marks":["superscript"],"text":"12","_key":"756228bca86b"},{"_key":"7d79a8110cd1","_type":"span","marks":[],"text":" If a firearm is kept in the home, keeping the gun locked, unloaded, and storing ammunition in a separate, locked location are steps with a demonstrable protective effect against suicide attempts."},{"_type":"span","marks":["superscript"],"text":"13","_key":"1f6449155739"},{"_type":"span","marks":[],"text":" Johnny did not keep his firearm locked, resulting in less than 30 seconds of film time passing between pulling out the handgun and dying from a self-inflicted gunshot.","_key":"605a5e80df91"}],"_type":"block","style":"normal","_key":"edb770d47ddb"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"86f71956c3ab0"}],"_type":"block","style":"normal","_key":"6e113f4c6797"},{"_key":"4c7fb413095a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Johnny’s death is also consistent with the short-term, impulsive nature of many suicide attempts. ","_key":"d14c638c32ac0"},{"_type":"span","marks":["em"],"text":"The Room","_key":"d14c638c32ac1"},{"_type":"span","marks":[],"text":" shows no evidence that Johnny had been contemplating suicide prior to the few minutes he spent trashing his apartment in a state of despair. This is an accurate depiction of how quickly suicidal thoughts can transition to a suicide attempt. One study found that nearly half of patients hospitalized after a suicide attempt reported that the time between their first thought of suicide and the attempt was 10 minutes or less.","_key":"d14c638c32ac2"},{"text":"14","_key":"6183c620b977","_type":"span","marks":["superscript"]},{"marks":[],"text":" Such transient, impulsive attempts can be addressed using preventive strategies that delay the time between a person’s thought of suicide and their ability to fatally act on that thought. 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","_key":"5c5e47e8bd0f1"},{"_type":"span","marks":["strong"],"text":"Dr Wall","_key":"5c5e47e8bd0f2"},{"_type":"span","marks":["em"],"text":" is a professor and director of the film studies minor at Utah State University, Logan, UT.","_key":"5c5e47e8bd0f3"}],"_type":"block","style":"normal","_key":"746cf0913468"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"71c447fb9b5f0","_type":"span"}],"_type":"block","style":"normal","_key":"e1ca3aeb9059"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"References","_key":"4a39efb6f5880"}],"_type":"block","style":"normal","_key":"2c2e4d80e273"},{"_type":"block","style":"normal","_key":"09fbbb1501ba","markDefs":[],"children":[{"_type":"span","marks":[],"text":"1. Wiseau T. The Room. Chloe Productions, TPW Films; 2003.","_key":"89b44b88aa050"}]},{"markDefs":[{"blank":true,"_type":"link","href":"https://www.washingtonpost.com/entertainment/the-room-is-the-worst-movie-ever-made-but-ive-seen-it-a-hundred-times--without-irony/2017/11/30/6475b096-d3ae-11e7-b62d-d9345ced896d_story.html","_key":"92505edb397a"}],"children":[{"_type":"span","marks":[],"text":"2. Park G. ‘The Room’ is the worst movie ever made, but I’ve seen it a hundred times – without irony. ","_key":"4bf0d7cf7f9d0"},{"_type":"span","marks":["em"],"text":"The Washington Post","_key":"4bf0d7cf7f9d1"},{"_type":"span","marks":[],"text":". December 1, 2017. Accessed October 18, 2024. ","_key":"4bf0d7cf7f9d2"},{"text":"https://www.washingtonpost.com/entertainment/the-room-is-the-worst-movie-ever-made-but-ive-seen-it-a-hundred-times--without-irony/2017/11/30/6475b096-d3ae-11e7-b62d-d9345ced896d_story.html","_key":"4bf0d7cf7f9d3","_type":"span","marks":["92505edb397a"]}],"_type":"block","style":"normal","_key":"ecf96d405268"},{"_key":"bbcf829c0793","markDefs":[{"blank":true,"_type":"link","href":"https://variety.com/2023/film/news/bob-odenkirk-the-room-remake-tommy-wiseau-1235547708/","_key":"109d56b4e9c7"}],"children":[{"_type":"span","marks":[],"text":"3. Murphy JK. Bob Odenkirk will take on Tommy Wiseau’s ‘The Room’ role in new tribute film: ‘I tried my best to sell every line.’ ","_key":"e8148c7a9de80"},{"_type":"span","marks":["em"],"text":"Variety","_key":"e8148c7a9de81"},{"text":". March 8, 2023. Accessed October 18, 2024. 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How his colleagues, and the American medical establishment at large, can help IMGs realize their dreams"}],"_type":"block"},{"_type":"block","style":"normal","_key":"74d246fe6a22","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dr Reda ","_key":"34632bc0fd361"},{"_type":"span","marks":["em"],"text":"is a practicing psychiatrist, Providence Healthcare System, Portland, OR.","_key":"34632bc0fd362"}]}],"is_visible":true,"documentGroup":null,"_updatedAt":"2021-01-14T17:30:00Z","contentCategory":{"_id":"93d57b69-2d72-45fe-8b8a-d18e7e7e5f20","_updatedAt":"2020-02-25T09:31:48Z","_createdAt":"2020-02-25T09:31:48Z","_rev":"snQqhhB4O8T5bi1viURsgs","_type":"contentCategory","name":"Podcasts"},"title":"The Road Less Travelled: An Immigrant’s Story","published":"2020-12-02T17:00:00.000Z","url":"road-less-travelled-immigrants-story","_type":"article","thumbnail":{"_type":"mainImage","asset":{"_ref":"image-882c03d79aad20809abba7ed419641756c66f364-3000x3000-jpg","_type":"reference"}},"_rev":"TbqMXpYjMCq36Bl7nKvL2A","targeting":{"content_placement":["topics/cultural-psychiatry","commentary/early-career-psychiatry"],"document_url":["road-less-travelled-immigrants-story"],"document_group":null,"rootDocumentGroup":[],"issue_url":"","publication_url":""},"relatedArticles":[{"title":"Mind the Media: Teaching Psychiatry Fellows to Engage in Media Meaningfully","url":{"current":"mind-the-media-teaching-psychiatry-fellows-to-engage-in-media-meaningfully","_type":"slug"},"thumbnail":{"_type":"mainImage","alt":"social media","caption":"C Malambo/peopleimages.com/AdobeStock","asset":{"_ref":"image-bdf5dace2c072a68253322128cf0897e6c1db712-8192x4738-jpg","_type":"reference"}},"published":"2024-11-27T15:00:00.000Z"},{"title":"Engaging With Critical Psychiatry: Advice for Early Career Clinicians","url":{"_type":"slug","current":"engaging-with-critical-psychiatry-advice-for-early-career-clinicians"},"thumbnail":{"asset":{"_ref":"image-842237b1a1f30b4a86e54b48fb24c839fcab1a36-4000x2286-jpg","_type":"reference"},"_type":"mainImage","alt":"psychiatry brain","caption":"yesdoubleyes/AdobeStock"},"published":"2024-11-13T15:00:00.000Z"},{"title":"Psychiatry and the “Worst Movie Ever Made”","url":{"current":"psychiatry-and-the-worst-movie-ever-made","_type":"slug"},"thumbnail":{"_type":"mainImage","alt":"The Room","asset":{"_ref":"image-5c5eb5261d37ebc4b8816d53ac424e858fb059f7-282x365-jpg","_type":"reference"}},"published":"2024-10-23T15:00:00.000Z"},{"title":"Armenia and Our Current Military, Cultural, and Psychological Genocides","url":{"current":"armenia-and-our-current-military-cultural-and-psychological-genocides","_type":"slug"},"thumbnail":{"asset":{"_ref":"image-80ce53f002b11c7c305c3eecb8235de6eec3387f-4001x1846-jpg","_type":"reference"},"_type":"mainImage","alt":"war trauma","caption":"alstanova@gmail.com/AdobeStock"},"published":"2024-09-16T12:50:27.265Z"},{"title":"Cultural and Religious Recommendations for Ethical Clinician/Patient Matches","url":{"current":"cultural-and-religious-recommendations-for-ethical-clinician-patient-matches","_type":"slug"},"thumbnail":{"caption":"Jon Anders Wiken/AdobeStock","asset":{"_ref":"image-f7b292b1cd422dd47c0eec66046c7779c1c2f259-6000x4000-jpg","_type":"reference"},"_type":"mainImage","alt":"ethics"},"published":"2024-09-09T12:52:26.282Z"},{"title":"Treating Prolonged Grief Disorder: Innovations and Future Directions","url":{"current":"treating-prolonged-grief-disorder-innovations-and-future-directions","_type":"slug"},"thumbnail":{"_type":"mainImage","alt":"grief","caption":"Tanya/AdobeStock","asset":{"_ref":"image-8a8e5624d757857f8eae5cc4d0bb4afd3d355744-3576x1870-jpg","_type":"reference"}},"published":"2024-09-05T15:00:00.000Z"}]},{"authorMapping":[{"url":{"current":"h-steven-moffic-md","_type":"slug"},"profileThumbnail":{"_type":"mainImage","asset":{"_ref":"image-e77c102ec2551e8a1b83af69c6de198a434395a8-481x485-jpg","_type":"reference"}},"authorType":"expert","displayName":"H. Steven Moffic, MD","_createdAt":"2020-02-21T11:23:21Z","_rev":"H5qC5rBIGDllCmOKKfAlcv","_type":"author","_id":"pst_author_322595","biography":[{"markDefs":[],"children":[{"marks":["strong"],"text":"Dr Moffic","_key":"ada5b7a9b843","_type":"span"},{"_type":"span","marks":[],"text":" ","_key":"207bec418af2"},{"_type":"span","marks":["em"],"text":"(he/him/his)","_key":"9766b78b3fdb"},{"_type":"span","marks":[],"text":" ","_key":"5d0b1559606f"},{"_type":"span","marks":["em"],"text":"is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry, and is now in retirement and refirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry \u0026 Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: ","_key":"4f58f875b316"},{"_type":"span","marks":[],"text":"Islamophobia, anti-Semitism, Christianity","_key":"fd8fc3638eb6"},{"marks":["em"],"text":", and now","_key":"5b7add5cf7c0","_type":"span"},{"text":" The Eastern Religions, and Spirituality","_key":"4a00caaa2c0a","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":". 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This guideline was a remnant of Freud’s recommendation for a “blank screen” for the analyst conducting psychoanalysis. The reason had to do with allowing the clinician to more easily represent an authority figure in the patient’s transference to the clinician."}]},{"_type":"block","style":"normal","_key":"48a693d5d5f4","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"53be8641c8fc0"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"It was pre-internet, so it was difficult for would-be patients to find out much about me other than word of mouth. Occasionally, someone would also ask to see me because of a book of mine they heard about or read, like ","_key":"c183912bcab00"},{"marks":["em"],"text":"The Ethical Way: Challenges \u0026 Solutions for Managed Behavioral Healthcare","_key":"c183912bcab01","_type":"span"},{"_type":"span","marks":[],"text":", which might suggest to them that I was ethical!","_key":"c183912bcab02"}],"_type":"block","style":"normal","_key":"de83dc4a8977"},{"_type":"block","style":"normal","_key":"bea31a102010","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c119d68816f90"}]},{"_key":"3c4af475378a","markDefs":[],"children":[{"marks":[],"text":"How clinical self-disclosure has changed with the internet and social media! Now, intentionally or not, much personal material is available about most any clinician. Presumably, the benefit of that is that a patient could anticipate and even request certain characteristics of the clinician, including for a certain religious and cultural identity. That sets up an expectation of an initial positive therapeutic alliance. The usual underlying question is what are the benefits or risks of various patient/clinician cultural and religious matches.","_key":"2667658673f90","_type":"span"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"7246de97c315","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"102179b6d1bf0"}]},{"style":"normal","_key":"1c101460e717","markDefs":[],"children":[{"_type":"span","marks":[],"text":"However, there is an unanticipated problem with such open information about a would-be or current therapist. As I discussed in the August 15, 2024, column on “Blacklisting Psychiatric Clinicians,” colleagues can often support or deny certain referrals. For example, stimulated by the Israel-Hamas war, certain referral processes and listservs are recommending against any clinicians “with Zionist affiliations” since they contribute to White Supremacy. This stance also ignores that Jews are generally not part of the “white” population.","_key":"168e2a81a77c0"}],"_type":"block"},{"children":[{"text":"","_key":"539b7fd0f1a60","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"bcac52e2c2c2","markDefs":[]},{"markDefs":[],"children":[{"text":"Extending this issue into the actual psychotherapy brings up the question of whether clinicians should convey their political, cultural, and religious preferences into the treatment interchanges. The risk is to offend the patient or to turn the therapy into a political discussion. On the other hand, psychotherapists must be humble, competent, and sensitive to the cultural concerns that patients may want and need to explore as part of their presenting psychiatric problems.","_key":"ccba142deaad0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"347e52cc5ee7"},{"_type":"block","style":"normal","_key":"e50d72b08e5f","markDefs":[],"children":[{"text":"","_key":"31cd7e4a10290","_type":"span","marks":[]}]},{"children":[{"text":"Whereas this column has often discussed how our expertise in patient care can be applied to society, these self-disclosures, intentional or not, are situations where society is intruding into individual patient care. Another example concerns climate change. Clinicians rightly concerned about the adverse health and mental health implications of climate change may also unnecessarily and erroneously push that into the sacred space of treatment.","_key":"d95a77ea05850","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"33e0bc7d5da9","markDefs":[]},{"_key":"507b210fbcc8","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6a018b7737ec0"}],"_type":"block","style":"normal"},{"_key":"15e421711c3d","markDefs":[],"children":[{"text":"While standards for handling these new challenges seem to be in flux, and might get even more complex as AI is increasingly used for matching, falling back on basic ethical principles can be invaluable. In ","_key":"b265438572e90","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"The Principles of Medical Ethics, With Annotations Especially Applicable to Psychiatry","_key":"b265438572e91"},{"text":", the Preamble clearly states that patient needs come first, not those of clinicians. That would imply that until proven otherwise, that as much responsibility for therapist preferences can be—and should be—given to patients. This approach also fulfills the bioethical principle of patient autonomy.","_key":"b265438572e92","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7e250424c2810"}],"_type":"block","style":"normal","_key":"1a4276fa8209"},{"children":[{"_type":"span","marks":[],"text":"Secondarily, we have an ethical responsibility to colleagues, meaning political reasons for excluding colleagues are unethical. So is pushing the beliefs of the therapist onto the patient. It is ethical, however, for a clinician to choose who to treat based on their cultural identities and beliefs. Moreover, it is ethical for the psychiatrist to address their cultural and religious societal concerns outside of the patient care cocoon (","_key":"0745f4b8e3f60"},{"_key":"568f77b690ac","_type":"span","marks":["strong","00e4ae2e83f0"],"text":"Table"},{"_type":"span","marks":[],"text":").","_key":"e531690a5e98"}],"_type":"block","style":"normal","_key":"a0803eb83002","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F0b3772ff93c390c8e73f67c3cf5054e15d2d5cd7-858x220.png%3Ffit%3Dcrop%26auto%3Dformat\u0026w=1920\u0026q=75","_key":"00e4ae2e83f0"}]},{"blank":true,"disableTextWrap":false,"widthP":50,"_type":"figure","imgcaption":[{"style":"normal","_key":"014a64a23376","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Table. ","_key":"a50bbfcd012f0"},{"text":"Ethical Cultural and Religious Guidelines in Patient Care","_key":"1bf5a86ebfa2","_type":"span","marks":[]}],"_type":"block"}],"_key":"1c4ef02e5b5b","alignment":"right","disableLightBox":true,"alt":"Table. Ethical Cultural and Religious Guidelines in Patient Care","asset":{"_ref":"image-0b3772ff93c390c8e73f67c3cf5054e15d2d5cd7-858x220-png","_type":"reference"}},{"_key":"84aa358b82d3","markDefs":[],"children":[{"marks":[],"text":"","_key":"77c6e75a11c40","_type":"span"}],"_type":"block","style":"normal"},{"children":[{"marks":[],"text":"All of these cultural and religious matching processes have crucial implications for the initiation of psychiatric treatment. Accompanying that as best as possible comes ongoing human clinical expertise, empathy, compassion, and caring.","_key":"e014b63d862f0","_type":"span"}],"_type":"block","style":"normal","_key":"db37b83a72fd","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"7a6cb39da2e80"}],"_type":"block","style":"normal","_key":"e16ecc67acd3","markDefs":[]},{"children":[{"marks":["strong"],"text":"Dr Moffic","_key":"b8ff9ca1cfdf0","_type":"span"},{"_type":"span","marks":[],"text":" ","_key":"b8ff9ca1cfdf1"},{"_type":"span","marks":["em"],"text":"is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry \u0026 Society,” since the COVID-19 pandemic emerged. 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They can be seen in our families, communities, work cultures, leisure activities, and other aspects of daily living. The ideals promoted by social media regarding the way individuals view themselves and others are consequential. From digital tools that alter images and augmented reality beauty filters, to Tik Tok and Reel makeup tutorials, individuals are constantly bombarded with images of quixotic beauty. These ideals are perpetuated and capitalized on by the beauty industry, as exemplified by what is a $374.18 billion dollar beauty industry that is projected to grow to $758.05 billion dollars by 2032.","_key":"c8c265a347ab0","_type":"span","marks":[]},{"_key":"3bd7bc4d854d","_type":"span","marks":["superscript"],"text":"1"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"58cd4196add70"}],"_type":"block","style":"normal","_key":"ca048c029c73"},{"_key":"ccb81fe81878","markDefs":[],"children":[{"_type":"span","marks":[],"text":"When individuals are experiencing body-focused repetitive behaviors (BFRBs), such as hair pulling, skin picking, or nail biting, the promotion of such ideals can have a profoundly negative impact on self-concept and present challenges to treatment and recovery. Moreover, the value placed on hair, skin, and nails vary across ethnic groups, gender identities, and sexual orientations, and may present additional challenges to care. Careful consideration of the complex interplay between cultural identities, their associations with beauty, and the experience of BFRBs, may improve case conceptualization and treatment outcomes.","_key":"06875ed4d2810"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"","_key":"d167dae9e7220"}],"_type":"block","style":"normal","_key":"a60b6cacc8f8","markDefs":[]},{"markDefs":[],"children":[{"text":"The Symbolic Meaning of Hair, Skin, and Nails","_key":"8d15bcb9856f0","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"0c024cc513f4"},{"markDefs":[],"children":[{"_key":"bbc083c9ee1e0","_type":"span","marks":[],"text":"Throughout history, the appearance of hair, skin, and nails have held symbolic meaning. There are many examples in which hair cutting served as a means of social control, dehumanization and humiliation, such as in Nazi hair-taking or in military cultures. Long, flowing hair; smooth, clear skin; and manicured nails have been associated with sexuality and beauty. In lesbian and gay culture, hair has been used to communicate sexual identity, practices, and preferences.“Many members of the queer community have historically utilized clothing and style choices as a way to express their identity and signal to others who they are, especially throughout history when more people remained closeted, people could provide subtle hints via their clothing, style, and hair… Now, it can be a way to signal boldly and be unapologetically who you are.”"},{"_type":"span","marks":["superscript"],"text":"2","_key":"263ce36f9077"},{"_type":"span","marks":[],"text":" One individual described their experience: “I 100% used my hair to appear more queer and to feel like I fit in more in queer spaces.”","_key":"3db28852d956"},{"_type":"span","marks":["superscript"],"text":"3","_key":"dd620c7fd1dc"}],"_type":"block","style":"normal","_key":"e1020513c14a"},{"style":"normal","_key":"17788a1ad7e1","markDefs":[],"children":[{"_key":"a75773dafa4c0","_type":"span","marks":[],"text":""}],"_type":"block"},{"_key":"3ee5bd831580","markDefs":[],"children":[{"_type":"span","marks":[],"text":"In African American culture, afros and dreadlocks have been worn as a symbol of racial pride. For example, hair braiding has been a celebrated art form among African women since at least 3500 BCE, holding cultural and personal significance within Black communities, and continues to signify shared experience and solidarity among many Black women in the context of historic and present-day oppression.","_key":"6f0ae3144c2c0"},{"_type":"span","marks":["superscript"],"text":"4","_key":"c7df58162767"},{"text":" In indigenous North American tribes, hair has represented cultural identity and played a role in socialization and cultural celebrations. One indigenous American writes of the significance of hair, “Our hair is considered sacred and significant to who we are as an individual, family, and community. In many tribes, it is believed that a person’s long hair represents a strong cultural identity. This strong cultural identity promotes self-esteem, self-respect, a sense of belonging, and a healthy sense of pride. As part of the practice in self-respect, we are taught to take good care of our hair through proper grooming. In preparation for ceremonies, we take great care in the grooming, styling, and ornamentation of our hair. Our hairstyle and ornamentation are guided by the values of our family and tribe. It is a form of creative self-expression that reinforces our connection to our family, tribe, and Creation.”","_key":"ea54118d6216","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"5","_key":"dd93c6d972e2"},{"_type":"span","marks":[],"text":" Hair has also been used to convey messages about marital commitments, lifestyles, group identity, and self-expression across cultures.","_key":"4293ff983587"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"1374902de94a","markDefs":[],"children":[{"marks":[],"text":"","_key":"b0e579201ddb0","_type":"span"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Hairdressing or cutting of the hair is often associated with rites of passage. In Asian cultures, hair has traditionally been a symbol of social status, religious beliefs, womanhood, and political affiliation. In Orthodox and Hasidic Jewish culture, hair may demonstrate rites of passage (eg, upsherin/chalakah), and group identity or marital status (eg, wigs, tichel, shpitzel, sheitel, sudra). Orthodox and Hasidic Jewish men may wear payes (ie, earlocks) or shave their face in a certain manner. In Islamic culture, the mustache is seen as a sign of masculinity and virility, and Islamic women may wear head coverings (eg, hijab, burka, keffiyeh) as a symbol of modesty.","_key":"96b1236094690"}],"_type":"block","style":"normal","_key":"d1bf42657c4d"},{"_type":"block","style":"normal","_key":"d31c288cca9c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b3bfecf80ce60"}]},{"_key":"221e2f48a330","markDefs":[],"children":[{"_type":"span","marks":[],"text":"In addition to the symbolic meaning of hair, there are also values and practices involving skin and nails across cultures. In Jewish culture, circumcision of baby boys (ie, bris/brit milah) has been carried out for thousands of years in accordance with the Tanakh (ie, Hebrew Bible) symbolizing religious affiliation.","_key":"a0d3e41934870"},{"text":"6","_key":"6cf9db2b2fe0","_type":"span","marks":["superscript"]},{"marks":[],"text":" Skin painting, tattooing (eg, Austronesian groups, Indigenous North American tribes), scarification (eg, West African tribes), piercing (eg, African and American tribal cultures), and amount of skin exposure in view of others (eg, Jewish and Islamic cultures) may also convey meaning and group affiliation. Nail manicuring, painting, and accessorizing also have cultural and societal meanings (eg, Asian, European, and American cultures). The longstanding history of value placed on nails began in ancient Egypt in 3200 BC, where manicures and pedicures were symbols of luxury and status; and, in China where the first nail polish was created and considered a symbol of femininity, wealth, and power.","_key":"2e83a63a130a","_type":"span"},{"text":"7","_key":"2a1a1533e8f9","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" Nail fashion continues to have significance in contemporary societies. A recent study of African American college students found that nail fashion represented a form of creative self-expression.","_key":"25cc910b6884"},{"_type":"span","marks":["superscript"],"text":"8","_key":"b4d35c38c0ab"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"3a017d7544720","_type":"span"}],"_type":"block","style":"normal","_key":"e5f6221fa85e"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Hair, Skin, Nails, and Physical/Mental Health","_key":"a01bd20d8af00"}],"_type":"block","style":"normal","_key":"022e67f8bde0"},{"_key":"7a7d47104337","markDefs":[],"children":[{"marks":[],"text":"The appearance of health of hair, skin, and nails may serve as an indication of one’s health status. Alterations of these physical attributes may suggest heart disease, anemia, thyroid dysfunction, diabetes, malnutrition, eating disorder, or BFRB. Approximately 1 in 20 individuals experience a BFRB, behaviors that involve biting, pulling, picking, or scraping one’s own hair, skin, or nails that result in damage to the body. BFRBs are not just an American phenomenon; they occur at similar rates across cultures and demographics.","_key":"789e85ebc7850","_type":"span"},{"text":"9,10","_key":"41215b778012","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" There has been very little attention on the cultural impacts of BFRBs or discussion of the ways in which damage to the hair, skin, or nails impacts how individuals experience their culture. Some faiths, including Christians, believe that our bodies are not our own and are believed to be a temple of the Holy Spirit.","_key":"af6100f749e6"},{"_type":"span","marks":["superscript"],"text":"11","_key":"4dd30c695159"},{"marks":[],"text":" Damage to the body is seen as sinful.","_key":"66f1134d040c","_type":"span"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"74a6f02059b90"}],"_type":"block","style":"normal","_key":"02b3562c3423"},{"_type":"block","style":"normal","_key":"de91df769907","markDefs":[],"children":[{"_type":"span","marks":[],"text":"It is important to explore the impact of beauty-centered culture on individuals experiencing BFRBs and the ways in which cultural and religious beliefs may deepen shame and limit participation in meaningful events and milestones. Although a paucity of research has examined the experience of shame, a very common and significant experience in BFRBs, existing data suggests that the emotional toll of living with a BFRB is similar across cultures, including shame, low self-esteem, sadness, and feelings of unattractiveness.","_key":"b58a40934f920"},{"_key":"00209386ff64","_type":"span","marks":["superscript"],"text":"12,13"}]},{"_type":"block","style":"normal","_key":"8fbe6bd55595","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"9fdc8a8658780"}]},{"children":[{"_type":"span","marks":["strong"],"text":"The Impact in Intersectionality","_key":"02d6e9a995610"}],"_type":"block","style":"normal","_key":"1c9159bb0f2b","markDefs":[]},{"_type":"block","style":"normal","_key":"a8c1a18739f7","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Only recently has there been an examination of the impact of intersectional stigma in individuals who report experiencing a BFRB. Research suggests that stigma may combine when individuals are part of 2 or more identities that experience prejudice which results in emotional damage (O Deerin, J Stevenson, University of Glasgow, written communication, April 2024). An initial study regarding the experience of mental illness stigma in the LGBTQ+ community demonstrated that BFRB symptomatology may be more prevalent in the LGBTQ+ community compared to a cisgender population (N Pokorna, J Stevenson, University of Glasgow, written communication, April 2024). The LGBTQ+ group also experienced greater levels of negative emotional states, discrimination, intersectional stigma, and family rejection. Transgender participants with BFRBs reported greater dysmorphic appearance concern. Overall, the study suggests that individuals in the LGBTQ+ community may experience an increase in symptomatology because of these intersectional factors.","_key":"bb96345fd6850"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"4ea2e71e66b40"}],"_type":"block","style":"normal","_key":"05dd18412233"},{"markDefs":[],"children":[{"text":"The Role of Emotion in BFRBs","_key":"299f46179ea80","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"5433b624c60b"},{"style":"normal","_key":"072f8608fe56","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Emotions play a vital role in the cycle of BFRBs. Individuals with a BFRB may be more vulnerable to intense emotional experiences, difficulties in regulating those emotions, and emotion-driven impulsivity.","_key":"aac5aec53a1c0"},{"_type":"span","marks":["superscript"],"text":"14,15","_key":"82dc3909d299"},{"_type":"span","marks":[],"text":" Sensitivity to shame is associated with BFRBs and is identified as a key emotional experience prior to and following a BFRB episode. Furthermore, shame is positively correlated with BFRB symptom severity, distress, and body dissatisfaction.","_key":"a90a7565abd8"},{"_type":"span","marks":["superscript"],"text":"16","_key":"dbd6eb517a1f"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"","_key":"f351684dd4fb0"}],"_type":"block","style":"normal","_key":"c36c8007b9a3","markDefs":[]},{"style":"normal","_key":"8549ad293fb6","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The emotion regulation model of BFRBs posits that BFRBs serve the function of immediate self-regulation. BFRBs are often associated with increased feelings of pleasure, relief, and decreased boredom in the initial stages of the behavior cycle, but trend toward negative emotions, such as anger and anxiety over time.","_key":"967bbb2d47960"},{"marks":["superscript"],"text":"13","_key":"16d27d256766","_type":"span"},{"_type":"span","marks":[],"text":" As a result, individuals report that the long-term emotional impact of experiencing BFRBs include feelings of shame, sadness, frustration, low self-esteem, feelings of unattractiveness, depression, and decreased levels of calmness.","_key":"28f74884ca24"},{"_type":"span","marks":["superscript"],"text":"12,13","_key":"5cfa161f6a7c"},{"_type":"span","marks":[],"text":" These longer-term consequences may thus be perpetuated by serving as internal discomforts which are met with a BFRB in an attempt to self-regulate.","_key":"62eedc13d5ca"}],"_type":"block"},{"_key":"4bc2fb7f5a6e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"428bec74b0e20"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Research further suggests that shame and maladaptive cognitive emotion regulation strategies predict BFRB symptoms, and shame mediates the relationship between perfectionism and BFRB symptoms, suggesting that interventions targeting shame may be useful for treatment.","_key":"0450286aecf90"},{"text":"17","_key":"35df056c5f80","_type":"span","marks":["superscript"]}],"_type":"block","style":"normal","_key":"21ccdddb85f4"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"01c3a248b0cd0"}],"_type":"block","style":"normal","_key":"9e6cc14e62a1"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The BFRB Reinforcement Cycle can be seen in the ","_key":"63aa463ab9b00"},{"_type":"span","marks":["strong"],"text":"Table","_key":"63aa463ab9b01"},{"_key":"63aa463ab9b02","_type":"span","marks":[],"text":"."}],"_type":"block","style":"normal","_key":"7469611ad0be"},{"blank":true,"disableTextWrap":false,"asset":{"_ref":"image-e24d9cfe7594f9466c7832a3c3aff3469bf31616-936x470-jpg","_type":"reference"},"alt":"Table. The BFRB Reinforcement Cycle ","_type":"figure","_key":"f66c66b7a271","imgcaption":[{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Table. 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In considering potential cultural factors that are relevant to an individual’s BFRB experience, it may be helpful to inquire about the cultural groups with which the individual identifies (eg, family, friends, community, religion, ethnicity, nationality, sexuality, gender, etc) and about the messages received within these contexts. Factors to consider include:","_key":"54fd50b0b4650"}],"_type":"block","style":"normal"},{"style":"normal","_key":"3bc8b90061e3","listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Messages about beauty, attractiveness, femininity/masculinity","_key":"1e076a94502d0"}],"level":1,"_type":"block"},{"markDefs":[],"children":[{"_key":"6de22ef7bfa30","_type":"span","marks":[],"text":"Messages about hair, skin, or nails"}],"level":1,"_type":"block","style":"normal","_key":"350d50408e9d","listItem":"bullet"},{"_type":"block","style":"normal","_key":"87ad81fd02cb","listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Messages about what is right vs wrong","_key":"581a2eddb2760"}],"level":1},{"style":"normal","_key":"87e02ff10a52","listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Messages about what it means to have a habit behavior","_key":"c7f8c806dd060"}],"level":1,"_type":"block"},{"level":1,"_type":"block","style":"normal","_key":"fe4b2659ff54","listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Messages about what it means to have a mental health disorder","_key":"8925feae17a20"}]},{"style":"normal","_key":"1f7e88b62fec","listItem":"bullet","markDefs":[],"children":[{"_key":"5c8ff03668650","_type":"span","marks":[],"text":"Messages about help-seeking behaviors for psychological well-being"}],"level":1,"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"Messages about locus of control","_key":"2cf45747fd120"}],"level":1,"_type":"block","style":"normal","_key":"6ce2b3d033a6","listItem":"bullet","markDefs":[]},{"_key":"d6a68a594eb5","listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Negative feedback from others or more subtle interactions about BFRBs, the overt and covert consequences of BFRBs, and any misunderstandings others may have had about the behavior","_key":"3ad2a08723cf0"}],"level":1,"_type":"block","style":"normal"},{"level":1,"_type":"block","style":"normal","_key":"cba38d159cfe","listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Self-judgment and negative self-talk resulting from difficult thoughts, emotions, or unwanted behaviors associated with the BFRB experience","_key":"5c4f2b6810b80"}]},{"children":[{"_type":"span","marks":[],"text":"The reinforcing nature of avoidance and isolation in an attempt to protect oneself from emotional pain","_key":"5bfcfd36be620"}],"level":1,"_type":"block","style":"normal","_key":"0d10bf8f3af3","listItem":"bullet","markDefs":[]},{"listItem":"bullet","markDefs":[],"children":[{"text":"Accessibility to evidence-based health care and appropriate support","_key":"99ec08b058790","_type":"span","marks":[]}],"level":1,"_type":"block","style":"normal","_key":"222b9378997f"},{"children":[{"_type":"span","marks":[],"text":"Potential impact of intersectional stigma","_key":"e04150117ec30"}],"level":1,"_type":"block","style":"normal","_key":"5f2a54ccfec7","listItem":"bullet","markDefs":[]},{"_type":"block","style":"normal","_key":"b3bf6adefe71","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ddfee2b74e630"}]},{"markDefs":[],"children":[{"text":"Treatment Considerations","_key":"f88de071bf700","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"af5d2cff7dd2"},{"style":"normal","_key":"43ee6d009c19","markDefs":[],"children":[{"_type":"span","marks":[],"text":"At the outset of treatment, it is critical for the clinician to have a foundation of clinical competency and approach each clinical encounter with curiosity, respect, and cultural humility. Providing psychoeducation regarding BFRBs in general, and a discussion about the individualized conceptualization of behavior and its reinforcement at the beginning of treatment may promote rapport and an open, therapeutic, working relationship. Depending on the individual’s circumstances, it may also be useful to provide psychoeducation to support persons and significant others in the context of a family (ie, multi-person) therapy session with the identified patient present. This may serve to address any misunderstandings, review educational information, and provide guidance regarding how to most appropriately support the individual.","_key":"0195c875f1d80"}],"_type":"block"},{"_type":"block","style":"normal","_key":"e3a5545fd9f8","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ee40af19b6ce0"}]},{"_key":"e5be80f901bb","markDefs":[],"children":[{"marks":[],"text":"With attention to information gleaned from self-monitoring and the exploration of a comprehensive functional behavioral analysis, strategizing interventions focused on experiential avoidance which results in the maladaptive BFRB is then planned. (As the scope of this article is focused on cultural considerations and the impact thereof, the breadth and depth of describing this treatment approach is limited to highlighting cultural considerations.) 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These standards, perpetuated by social media and a booming beauty industry, exacerbate feelings of inadequacy and shame among individuals with BFRBs. The symbolic meanings attached to hair, skin, and nails across various cultures further complicate these experiences, influencing how individuals perceive themselves and their behaviors. Effective treatment must therefore consider these cultural dimensions. By addressing the emotional underpinnings of BFRBs, particularly shame, and promoting adaptive emotion regulation strategies, therapists can enhance treatment outcomes. 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Lykos Therapeutics released a statement to provide additional insights on the outcome of this meeting.","_key":"ce258b0f75530"}],"_type":"block"},{"_type":"block","style":"normal","_key":"067083af4c65","markDefs":[{"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/view/lykos-therapeutics-releases-statement-on-fda-advisory-committee-meeting","_key":"1cd4ee38e1be"}],"children":[{"_key":"612d57cabf1c0","_type":"span","marks":[],"text":"“While we were of course disappointed by the outcome, we were not surprised by the important questions raised. We are advancing a novel treatment and have worked closely with the FDA over the course of years to address these complex issues. Ultimately, the final decision for the potential approval of midomafetamine rests with the FDA, and we are deeply committed to providing any information needed to enable its thorough review. We have full confidence in the rigor and thoughtfulness that the FDA will give our application,” said Amy Emerson, the CEO of Lykos Therapeutics. 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Designed to emulate a randomized controlled trial (RCT), the investigators compared the long-term responses to 17 antidepressants within their respective pharmacologic classes.","_key":"33e542ebcb050"}],"_type":"block"},{"style":"normal","_key":"155dfa6e0bf6","markDefs":[{"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/view/differences-in-long-term-response-among-antidepressants-for-mdd","_key":"20edb53f092d"}],"children":[{"_type":"span","marks":[],"text":"Lars Vedel Kessing, MD, of the Copenhagen Affective Disorder Research Centre, Psychiatric Center Copenhagen, and colleagues pointed out that clinical trials of antidepressants are commonly conducted against placebo, with few comparing active agents and fewer extending beyond short-term assessment of acute effects. ","_key":"e40cd9d9b7320"},{"_type":"span","marks":["20edb53f092d","strong"],"text":"Continue Reading","_key":"e40cd9d9b7321"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c7a1b5c877f7"}],"_type":"block","style":"normal","_key":"b2b0b2c7dfa9"},{"style":"normal","_key":"45656fcffd7c","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Donanemab: FDA Advisors Unanimously Recommend for Approval","_key":"98171ffe04bf0"}],"_type":"block"},{"widthP":40,"disableTextWrap":false,"disableLightBox":true,"_type":"figure","imgcaption":[{"_key":"6c0bfb6c6b13","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Ivelin Radkov/AdobeStock","_key":"8e85e41fe95f0"}],"_type":"block","style":"normal"}],"_key":"6f9b9dbca565","alignment":"right","asset":{"_ref":"image-65017fa82ca93fd6bd3b3df931fd580d663c7ba8-3840x2560-jpg","_type":"reference"}},{"style":"normal","_key":"2af052a4fc45","markDefs":[],"children":[{"_type":"span","marks":[],"text":"A panel of US Food and Drug Administration (FDA) advisors unanimously recommended Eli Lilly’s donanemab to treat Alzheimer disease, marking the next step towards potential full FDA approval later this year.","_key":"4e8c12e1a7b80"}],"_type":"block"},{"_key":"db8338c57c3f","markDefs":[{"_key":"3dbf11a64d31","blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/view/donanemab-fda-advisors-unanimously-recommend-for-approval"}],"children":[{"_key":"32605d0237b20","_type":"span","marks":[],"text":"In an initial vote, 11 panel members unanimously said that the available donanemab data shows that it is effective at treating the early stages of Alzheimer disease. However, several panel members noted the need for more data in minoritized groups, such as Black and Hispanic patients. Furthermore, the panel agreed that donanemab’s benefits outweigh its risks. "},{"_type":"span","marks":["3dbf11a64d31","strong"],"text":"Continue Reading","_key":"32605d0237b21"}],"_type":"block","style":"normal"},{"_key":"d84269a918c2","markDefs":[],"children":[{"text":"","_key":"7b674fc68a3c","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"History of Psychiatry: Its Relevance in Training and Beyond","_key":"d5f3514330520"}],"_type":"block","style":"normal","_key":"434505d2c554","markDefs":[]},{"disableLightBox":true,"_type":"figure","imgcaption":[{"_type":"block","style":"normal","_key":"2eb335557df6","markDefs":[],"children":[{"_type":"span","marks":[],"text":"tomertu/AdobeStock","_key":"71e9abf1d5690"}]}],"_key":"d6b9255988db","alignment":"right","asset":{"_ref":"image-f3a15d402347b3d3c6decdeeaf0781c36f5b162d-3840x2560-jpg","_type":"reference"},"widthP":40,"disableTextWrap":false},{"markDefs":[],"children":[{"_key":"f5e5f7cc92980","_type":"span","marks":[],"text":"Formal instruction on the history of psychiatry is currently a mandatory component of psychiatric residency training in the United States. The Accreditation Council for Graduate Medical Education (ACGME) requires psychiatry residents achieve competence in their knowledge of the “history of psychiatry and its relationship to the evolution of medicine.” The importance of this area of study has been recognized since at least the 1960s. A 1967 survey found that 44 teaching centers in the US and 2 in Canada were offering instruction on historical psychiatry, twice as many as in 1961. Since then, there has been increasing recognition of the importance of history for the development of the future psychiatrist."}],"_type":"block","style":"normal","_key":"2aa44ba9a022"},{"children":[{"_type":"span","marks":[],"text":"Here, we seek to highlight the relevance of the history of psychiatry not only in the training of residents but also in the day-to-day clinical work of the psychiatrist. One of us (QM) is a current psychiatry resident at Tufts Medical Center with interest in the history and philosophy of psychiatry, and the other (MR) is a psychodynamic psychotherapist who teaches history of psychiatry to residents at Tufts and the University of Central Florida. We have identified at least 5 reasons to study the history of the field. 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