is an outpatient psychiatrist at Prisma Health-Upstate and clinical associate professor at the University of South Carolina School of Medicine, Greenville. He served on the American Psychiatric Association’s Task Force to Address Structural Racism Throughout Psychiatry, and he currently serves as the Diversity and Inclusion section editor and advisory board member for

Articles

Sequelae

As of today, Friday June 24, 2022, the Supreme Court has overturned Roe v. Wade, holding that there is no longer a federal constitutional right to an abortion. This comes on the heels of the early draft of a majority opinion obtained by Politico in May where Justice Samuel Alito wrote they would strike down the landmark case. Going forward, states will determine abortion rights.

 contributors have many thoughts on this controversial decision. If you’re interested in reading more about the abortion issue , women’s health care, and how legislation affects mental health, you should check out the following articles.

“Although clinicians should support family planning and appropriate birth control, psychiatrists are acutely aware that mistakes happen and much of life is unplanned. Thus, there will remain a demand for abortion after access to the procedure or pharmacotherapy is restricted in parts of America.”

Would I Do the Same Approving of Abortions for Psychiatric Reasons as I Did 50 Years Ago?

“I wondered on and off if I would return to doing what I could when the need for abortion seemed to be endangering the mental health of the would-be mother and fetus—yes, and fetus.”

“Women deserve better. They deserve to feel safe inside and outside their homes, at their places of employment, in their houses of worship, and wherever they might be…”

“Maternal health is correlated with various factors including socioeconomic status, disease burden, and population dynamics. It is a poignant representation of the state of the country. The problem is multifactorial; it needs to be addressed on various levels, and we need systemwide organized and strategic efforts. Our patients are counting on us to address this issue.”

Do you have thoughts on the Supreme Court’s landmark decision? Share them with us at 

What do psychiatrists think of the overturning of Roe v. Wade? 

The Overturning of Roe v. Wade

 is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. To create a better world, he is an advocate for treating mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism. He serves on the Editorial Board of

Well, it is that time for a pop-up column again. As anticipated, the Supreme Court has just overturned 

, removing the constitutional right to abortion and opening up the likelihood of more formal legal denials of abortions in many states.

Though I am unofficially “retired” from clinical practice, I still have my medical license. In anticipation of this happening, I wondered on and off if I would return to doing what I could when the need for abortion seemed to be endangering the mental health of the would-be mother and fetus—yes, and fetus.

During medical school, my original required research project was about whether a pregnant woman’s emotional status influenced the development of the fetus, especially mental-health wise. I hypothesized it did, but never got to complete the research, choosing one on depression in medical inpatients instead. But, thankfully, by now there is more research on how emotional distress in pregnant mothers can adversely affect their babies.

My experience in the first half of my psychiatric residency at the University of Chicago had also been mentioned in the 

 article by the psychiatrist Sally Satel on June 4, “The ‘Open Secret’ on Getting a Safe abortion Before Roe v. Wade.”

 She suggested that I and others were committing small acts of rebellion by stretching ethical boundaries. She quoted me out of the context of the recent 

 article that I had written May 3rd on abortion, “Calling for a Psychiatric Analysis on the Mental Health Implications of Roe v Wade”

“I recommended abortion for all. My mental health analysis at the time was not only about the mental health of the would-be mothers, but their upcoming children if abortion was not done.”

However, the point of my original article was not what I did, but the need for organized psychiatry to prepare how we might respond if 

 ended. It has ended, but I have not seen any such plans. Most of us were taking risks to our reputations with our more underground involvement back before 

. Nevertheless, I would do it again if needed. After all, I have proudly been called a gadfly.

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

1. Satel SL. The ‘open secret’ on getting a safe abortion before Roe v. Wade. 

https://www.nytimes.com/2022/06/04/opinion/sunday/psychiatrists-abortion-roe.html

2. Moffic HS. Calling for a psychiatric analysis on the mental health implications of Roe v Wade. 

https://www.psychiatrictimes.com/view/calling-for-a-psychiatric-analysis-on-the-mental-health-implications-of-roe-v-wade

Roe v. Wade has been overturned. How will this affect the mental health of both mothers and fetuses? 

Experienced psychiatrists tend to take pride in having good communication skills, such as careful listening and patient-centered communication. That is one reason that dealing with difficult patients, who seem to thwart these skills, is so frustrating. Researchers suggest that 3 sources of difficulty may be present: the patient’s issues, the relationship between the clinician and the patient, and the systemic or social context of the encounter.

As for the patient’s issues, unfortunately, one thing that makes difficult patients difficult is that they seem to interact in a way that makes it hard to empathize with them. As for relationship issues, they often involve a perception by the patient that the clinician is not understanding them in an empathic fashion or is not communicating this empathy. In other words, improved empathic communication may be the key to success in encounters with difficult patients.

In one study, experienced psychiatrists demonstrated more empathy than residents,

 suggesting that they may learn more from repeated practice—in effect, from trial and error—than from training and education. Other than clinical experience, there is no unified model of how to educate clinicians in empathic communication skills, either in the field of psychiatry or in medicine generally.

Many educational intervention trials have attempted to improve the empathy of medical students, residents, and practicing physicians (including psychiatrists).

 They generally have been tested only for short-term results, have captured only a part of what empathic communication involves, and have quite different theoretical and practical approaches. Thus, this central clinical skill still has no generally accepted training approach.

Marjorie Heymann, PhD, a director of cutting-edge, avant-garde theater productions and a scholar of the psychology of theater, made a surprising observation: The skills involved in theater arts are precisely the skills of empathic communication. She noticed that the very essence of the theater experience, for both the audience and the actors, is immersion into the emotions, needs, and motivations of the characters as they interact with each other. If audience members do not bring emotional and motivational attentiveness to the experience, they do not really appreciate the art form and will likely not come back to the theater.

This observation led Heymann to her key insight: Certain systematic approaches used to train actors could be translated into a systematic approach for training clinicians to communicate empathically, even with difficult patients.

Heymann therefore developed a course that uses the art and heart of theater to deepen clinicians’ empathic communication skills: 

Working with Challenging Patients and Families: Maximizing Your Clinical Effectiveness

. The trainees include not only mental health clinicians but also primary care providers, who increasingly are required to treat common mental health disorders but typically have had little training in empathic listening.

As a psychiatrist with 30 years of experience, when I took the course, I was surprised at how it opened a whole new dimension of deep listening and empathic response. I was so impressed that I trained to be one of the co-teachers of the course with Heymann.

The Need for More Systematic Training in Empathic Communication:

Although psychiatrists tend to pride themselves on their skills in communication, they nevertheless can benefit from Heymann’s approach for 2 reasons. First, the emphasis in modern psychiatry on objective assessment of DSM-5 criteria and psychopharmacology has led to decreasing emphasis on the doctor-patient relationship.

 Yet psychiatrists value empathic engagement with their patients as a core competency.

 Thus, the current generation of trainees needs greater emphasis on empathic communication skills.

A key point is that communication skills are not just for delivering psychotherapy. The basic tasks of diagnostic interviewing or treatment planning require empathic communication as much as therapy does. To identify correct diagnoses or develop a plan the patient will follow, psychiatrists must understand the patient’s emotions, motivations, and relationship to the psychiatrist.

Second, even though psychiatrists already have communications skills, they can deepen their capacity for empathic listening. Difficult patients are difficult to communicate with. Their stories seem to change; they seem to ignore their psychiatrist’s advice and to undermine themselves at every step. Often, they are projecting the locus of problematic behaviors onto others. They may perceive that their psychiatrist does not respect them; they may not trust their psychiatrist. Such patients can challenge the empathy of even the most experienced clinicians. However, if psychiatrists can see the difficulty as their own inability to communicate empathically and resolve to improve their skills, even difficult patients can come to feel understood and become willing to participate in the therapeutic alliance.

With the increased demand for mental health services and the shortage of trained mental health clinicians, primary care providers (PCPs) are increasingly being asked to address mental health issues. Many PCPs have great skills in interviewing patients about their physical disorders but have little experience in communicating around emotional issues. The emerging model of mental health in primary care will call on psychiatrists to train, supervise, and collaborate with PCPs. Fortunately, Dr. Heymann’s course is a fast, efficient, and effective training program for imparting empathic communication skills to PCPs.

The Relationship Between Theater and Empathic Communication

The recognition that the experience of a theatrical performance depends on empathy goes as far back as Aristotle.

 When audience members leave the theater debating how well an actor portrayed a character, they are tapping into their empathic listening skills. Heymann understood that the untrained individuals who make up a theater audience have a highly empathic appreciation of the characters’ emotional states, needs, wants, and motivations. This appreciation depends on the actors’ ability to communicate empathically.

This insight led Heymann to work full-time to support actors in empathic communication. A key ingredient is the actor’s ability to listen to the other actors’ lines with deep attention and focus. The response—the actor’s own lines—then must combine that other-directed empathy with their ability to inhabit their own character’s reality. With this approach, actors can mobilize the audience’s potential for empathy.

After honing this approach for actors, Heymann had an epiphany: This systematic approach to inculcating empathy-based skills in actors could be a model for training clinicians to listen and speak empathically. With this insight, the idea for a course to improve clinicians’ empathic communication through theater arts was born.

How Theatrical Techniques Can be Used to Teach Empathy

There are many schools of thought about how to teach drama. Heymann identified basic common elements and organized them into a systematically sequenced structure. The unique contribution of her method is 

it teaches clinicians. It focuses on helping clinicians understand patients’ needs and motivations in the moment of the clinical encounter. It recognizes that clinicians can be present to patients’ needs and motivations only when they first have an empathic understanding of their own needs and motivations.

Heymann’s goal is not to turn clinicians into actors but to teach them how to empathize with their patients. Her course helps clinicians acquire a specific set of skills in a stepwise fashion. Acquisition of skills requires repeated practice, followed by critique, and eventually the addition of new skills with added practice and critique. Only with the basics of deep listening under their belt do participants tackle role plays, in which they begin to combine skills to understand the wants and needs of patients in all their complexity. The steps add up to a method to help clinicians provide what patients need and want most: to be understood, with kindness and empathy.

Heymann’s method begins by engaging clinicians in mindfulness exercises, followed by practice in dealing with distractions. Some distractions are relatively minor “before and after” needs, such as thinking about what one should have said in the argument last night or projecting how hard it will be to get to school on time to pick up one’s child. Others are major, such as worry about a serious illness or coping with a past or future loss. Heymann teaches participants first to respect these issues and then to clear them out of the way before the clinical encounter. We may be able to solve minor problems simply by taking a few minutes to think them through or making a call. For major distractions, Heymann recommends making an appointment with oneself to think about the issue and deal with the feelings: “Tonight from 9 to 10 pm, I will think about mom’s cancer diagnosis and consider how I can support her.”

Having set aside distractions, the clinician is ready to identify and acknowledge the specific needs they and their patients bring to the clinical encounter. Heymann outlines major categories of needs that both clinicians and patients are likely to bring into the room: the need for control, respect, help, and love (or liking), among others. Another salient need for clinicians is their patients’ trust; without this, clinicians cannot enlist patient participation in the healing process.

The genius of the theatrical approach to listening is learning to hear the needs beneath the words. Heymann emphasizes that listening for needs, as opposed to listening for emotions, can make a real difference in the empathic connection. Emotions are of course important, but they are also often changeable, vague, and difficult to capture. Needs are more concrete and often more easily understood.

A simple but powerful exercise involves using the same words to mean different things representing different underlying needs. A patient who says, “I do not think you can help me,” for example, could be expressing a need for control or could, paradoxically, be asking for help. To help clinicians learn to listen for meaning, and not just for the literal words, 2 course participants play a clinician and a patient, saying this dialogue with long pauses between each set of words:

The pair repeat this dialogue several times, with the patient communicating different needs each time: the need for help, the need for respect, or the need to antagonize. In the silences, the clinician can reflect on the needs underneath the words, attending deeply to both verbal and nonverbal clues. Participants who are watching this dialogue are asked to identify which need they perceive.

The exercise serves as a microscope on communication. By attending to this brief exchange over and over, the trainees become sensitized to slowing down and hearing all the rich meanings they might otherwise miss. Having heard the needs beneath the words, the trainees are in the position to hear each patient’s story as an actor inhabits a character. The ability not just to know about the situation, but to 

it from the patient’s perspective is the beginning of empathy.

Once a clinician achieves that experience, their words to the patient take on a different valence. The patient can then experience that the clinician is present and really making the effort to help. This kind of mutual empathic experience, which is rare in everyday communication, can draw the patient into a therapeutic alliance. At that point, the clinician can share information, enlist the patient’s agreement, and partner with them in a plan for healing—all based on deep understanding of the patient’s needs and wants.

After 2 days of immersion in this and similar exercises, course participants describe the effect on themselves and their communication skills as profound. Some participants who were hesitant to role play have expressed an understanding that empathic communication skills can be imparted only through experiencing the sequence of exercises. Others have expressed an appreciation of how the experiential learning mirrored the goal of experiencing the patient’s need, not just understanding it abstractly. Many have expressed frustration that they had not learned such basic and powerful skills in their professional training.

joined the faculty of Columbia University in 1992 as a clinical and research psychiatrist, where he worked on suicide risk factors, the long-term effects of childhood trauma such as exposure to 9/11 or the criminal justice system, and decision theory and game theory models in psychiatry. At 

, he helped develop a training program for primary care physicians on how to integrate mental health into primary care practice.

Managing ‘difficult’ patient encounters

2. Koekkoek B, Berno van Meijel CNS, Hutschemaekers G. 

“Difficult patients” in mental health care: a review

A comparative study of empathy: the effects of psychiatric training.

4. Esagian G, Esagian-Pouftsis S, Kaprinis SG. 

5. Patel S, Pelletier-Bui A, Smith S, et al. 

Curricula for empathy and compassion training in medical education: a systematic review

6. Bracken P, Thomas P, Timimi S, et al. 

Use of empathy in psychiatric practice: constructivist grounded theory study

Dealing With Difficult Patients

Richard Berlin, MD, shares Ross Gay's poem "

has been writing a poem about his experience of being a doctor every month for the past 24 years in

in a column called “Poetry of the Times.” He is instructor in psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts. His latest book is

Videos

"...you are the air of the now and gone..."

Thank You

Is there a way to psychiatrically understand the 1/6 Congressional committee hearings?

Humiliation and Dignity in Ukraine and Life

9 Mental Health Benefits of Title IX for Women on its 50th Anniversary

Listening to some of the hearings about the unprecedented and dangerous storming of our Capitol for a coup reminds me some of the psychotherapy process with a patient suffering from posttraumatic stress disorder. As in such patients, finding the truth in the history and memories of trauma is a slow process. Sometimes values trump the truth. Ultimately, for recovery, some positive reframing, as occurs in cognitive-behavioral psychotherapy, is necessary to move forward successfully.

In a typical trauma psychotherapy process, there are risks, such as pushing the trauma into consciousness too quickly. The therapist can also make interpretations that the patient is not ready to access and accept. False memories can be implanted. Truth by itself may not be therapeutic.

The patient in the hearings may be our country itself. The committee may represent the therapist, the witnesses the avoided memories, and the perpetrators the psychological resistance.

It seems like some of the repressed trauma emerged on Tuesday, tearfully and therapeutically. There was Arizona Republican House Speaker “Rusty” Bowers, who had resisted the conspiracy accusations of voter fraud, and then testified that because of his faith in the US Constitution, that what he was asked to do was “foreign to my very being.” Then were 2 Georgia election workers, a mother and daughter, who testified that they lived in fear after being wrongly accused of voter fraud.

I am not at all sure if this is an appropriate or understandable parallel approach to analyze the hearings. Applying concepts that pertain to an individual may or may not fit the dynamics of groups but, then again, people are people and we share common human nature characteristics. Untreated major trauma in an individual, and perhaps in a country, can greatly impair functioning indefinitely. After yesterday, there will be a break in the hearings, allowing for time for us all to reflect on what it all means so far and how to further respond.

One thing I do know for sure is that our country needs the psychological healing of our increasing divisiveness and conflicts through the reduction or removal of this invasive trauma internally in our minds and externally in society.

“Our country needs the psychological healing of our increasing divisiveness and conflicts…”

Trauma, Conspiracy, and Cognitive-Behavioral Therapy in the Congressional 1/6 Hearings

Exactly 50 years ago, on June 23, 1972, President Nixon signed into law Title IX of the Equal Education act. Here is what it said:

“No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance.”

Note that nothing is said specifically about sports, though the development of women’s sports is what has received the most publicity. Certainly, I would conclude that sports benefit mental health, but also promise possibility and shatter stereotypes. Here’s 9 benefits.

The Serendipity of Juneteenth and Father’s Day Coinciding

1. Participation in formal sports in schools has enhanced the self-esteem and body image of women, while reducing the perception of physical frailty.

2. Women have been competitive with men in endurance sports and those with specific skills not requiring extreme strength or speed, like fencing and shooting.

3. It eliminated quotas for the admission of women to colleges and universities, including postgraduate education in medicine and psychiatry. For example, from about 10% of all doctorates, women now earn over 50%.

4. It resulted in more women being able to receive tenure.

5. Despite such significant notable examples as the sexual abuse of women gymnasts, it seems to have reduced the proportion of sexual harassment, assault, and ensuing traumatic repercussions of women on campus.

6. It helped equalize financial assistance.

7. It helped to equalize student services and counseling.

8. Its benefits were extended to transgender athletes in 2021, although that has brought up the controversy of the benefits of the remnants of male physical development after physical transition to female athlete.

9. Most recent women business executives were athletes in school.

A current question is which sports, if any, should become integrated? How can this integration include transgender athletes? There is even a relevant question of how to define transgender, on a spectrum of boyness or girlness, or not. Moreover, sports are still dominated by a male model, leadership, and earning power.

From the start, there has been resistance by male administrators, as well as some racism, but ultimately the fairness and equality should also enhance the meaning of accomplishment.

H. Steven Moffic, MD, discusses the national mental health crisis and proposes 5 ways we can address these challenges.

Hiding in Plain Sight: Youth Mental Illness

Do you have an idea for how to address the national mental health crisis? Let us know at 

How can we address our national mental health crisis?

The Moffic Plan: A Not-So-Modest National Mental Health Recovery Program

“If it does not count, it is not counted.”This is an adage that succinctly describes a central issue for maternal mental health. The bane of reproductive psychiatrists’ work is the shocking lack of data in our field. As clinicians and educators, we work around the lack of evidence, we teach how to critically interpret the studies we do have, and we fight the battle against generalizations. We clarify with disclaimers and provide guarded assurances. Despite the effort, there are often situations where we have no way to provide a clear evidence-based recommendation. We need more high-quality data in the field.

The data we do have does not accurately capture outcomes for maternal health in the United States. For example, the maternal mortality ratio (MMR) is a generally quoted statistic to reflect maternal health. This rate is reported by the Centers for Disease Control and Prevention’s (CDC’s) National Center for Health Statistics and National Vital Statistics System (NVSS). Although this data set is frequently cited, it is incomplete.

 is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.”

 The maternal death captured by the MMR does not include causes of death related to mental illness such as suicide or overdose. They are excluded in the ICD-10 death codes used to classify maternal deaths. They are not counted.

In the CDC dataset, maternal death by suicide falls under the accidental and incidental causes. This definition was set by the World Health Organization (WHO) and is followed internationally. Mortality due to mental illness is not counted. Despite this, the US MMR has increased from 17.4 deaths per 100,000 pregnancies in 2018 to 23.8 in 2020. For reference, France, Canada, the United Kingdom, Australia, Switzerland, Sweden, and Germany all have MMR <10.

The other national reporting system in the United States is the Pregnancy Mortality Surveillance System (PMSS). Although the PMSS has a broader definition and time period for classifying death, it continues to exclude significant causes of mental health-related mortality. In PMSS, a 

 is defined as “the death of a woman while pregnant or within 1 year of the end of pregnancy regardless of the outcome, duration, or site of the pregnancy—from any cause related to or aggravated by the pregnancy or its management.” The specific categories of deaths reported by PMSS include “other cardiovascular conditions, infection or sepsis, cardiomyopathy, hemorrhage, thrombotic pulmonary or other embolism, cerebrovascular accidents, hypertensive disorders of pregnancy, amniotic fluid embolism, anesthesia complications, [and] other non-cardiovascular medical conditions.” The PMSS website does not mention suicide or overdose-related death or count either one as a category of mortality.

Deaths due to mental illness—namely suicide and overdose—are not counted by these 2 main sources of maternal mortality data. Because they are not counted, we are missing crucial information, and we lack data on how to best address these causes of mortality. We need this data to be able to effectively drive national and state-level initiatives, policies, and funding.

One of the ways the maternal health community has tried to better understand the full context of maternal mortality is via data provided by maternal mortality review committees (MMRCs). MMRCs are multidisciplinary committees that convene at the state or local level to comprehensively review deaths of women during or within a year of pregnancy. MMRCs use both clinical and non-clinical information to get a richer understanding of the events leading to each death. MMRC data includes the category of “mental health conditions.” This category includes “deaths due to suicide, overdose/poisoning, and unintentional injuries as determined by the MMRC to be related to a mental health condition.”

There are various challenges in datasets that are collected by states, with the national perspective being a primary challenge. The only current dataset we have to extrapolate national trends from is from 2008 to 2017. A total of 14 states’ MMRCs voluntarily shared data with CDC. The trends demonstrated by this set show that approximately 1 in 3 deaths among women during or within a year of pregnancy were pregnancy-related, with 23.6% of deaths occurring in the 43- to 365-day window. Mental health conditions were noted to be responsible for 8.8% of pregnancy-related deaths.

The data that we do have more readily available is in reference to maternal mental health morbidity. Various datasets exist to point out the high prevalence of mental illness in the perinatal time period, with the latest estimates indicating that at least 1 out of every 5 new mothers in the United States will experience some form of mental health concern.

 The United States has about 3.6 million children born every year. This suggests that there are about 750,000 mothers out there who need support, treatment, and assistance. Among those affected, 75% go untreated.

We have also established the impact of untreated maternal mental health conditions on both the woman and the child. Per the data that we do have, we know that these patients are more likely to have comorbid substance use

 and poor nutrition. These patients are also at risk of having breastfeeding challenges and to have fewer positive encounters with their baby.

 The impacts on the children are also well established. We know that the children born to and/or raised by mothers with untreated maternal mental health conditions are at high risk for low birth weight, preterm birth, and excessive crying.

 They have also been demonstrated to have longer NICU stays.

 Additionally, the parent-child relationship can be impaired and give rise to adverse childhood experiences that have already demonstrated impact on the long-term health of children.

Preventing maternal mental health morbidity and mortality is a complicated, yet vital task. Maternal health is correlated with various factors including socioeconomic status, disease burden, and population dynamics. It is a poignant representation of the state of the country. The problem is multifactorial; it needs to be addressed on various levels, and we need systemwide organized and strategic efforts. Our patients are counting on us to address this issue. At minimum, we need to have accurate accounting of the problem, policies to promote continuous health coverage, and national standards for timely screening and assessment of mental health conditions. 

Various professional societies, alliances, and organizations are developing educational materials, policies, and processes. It is essential for these groups to have ongoing support and ability to coordinate their efforts.

We need to start counting, and the count needs to change.

 is an associate professor of psychiatry at the University of Arizona College of Medicine – Tucson.

Dr Kalia wears many hats: She is a perinatal psychiatrist and an educator; she serves as the associate training director for the 

 Residency program; and she is the director of the Psychiatry Department’s Perinatal 

1. Hoyert DL. Maternal mortality rates in the United States, 2020. Centers for Disease Control and Prevention. Last reviewed February 23, 2022. Accessed May 20, 2022. 

https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm

2. Pregnancy mortality surveillance system. Centers for Disease Control and Prevention. Last reviewed April 13, 2022. Accessed May 20, 2022. 

https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm#trends

3. Pregnancy-related deaths: data from 14 U.S. maternal mortality review committees, 2008-2017. Centers for Disease Control and Prevention. Last reviewed April 13, 2022. Accessed May 20, 2022. 

https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/mmr-data-brief.html

ACOG committee opinion no. 757: screening for perinatal depression

Perinatal depression: a systematic review of prevalence and incidence

6. Fawcett EJ, Fairbrother N, Cox ML, et al. 

The prevalence of anxiety disorders during pregnancy and the postpartum period: a multivariate Bayesian meta-analysis

7. Byatt N, Levin LL, Ziedonis D, et al. 

Enhancing participation in depression care in outpatient perinatal care settings: a systematic review

Treatment of substance use disorders among women of reproductive age by depression and anxiety disorder status, 2008-2014

Postpartum depression effects on early interactions, parenting, and safety practices: a review

10. Fitelson E, Kim S, Baker AS, Leight K. 

Treatment of postpartum depression: clinical, psychological and pharmacological options

11. Grote NK, Bridge JA, Gavin AR, et al. 

A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction

12. Stein A, Pearson RM, Goodman SH, et al. 

Effects of perinatal mental disorders on the fetus and child

13. Cherry AS, Mignogna MR, Roddenberry Vaz A, et al. 

The contribution of maternal psychological functioning to infant length of stay in the Neonatal Intensive Care Unit

14. Felitti VJ, Anda RF, Nordenberg D, et al. 

Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. the Adverse Childhood Experiences (ACE) Study

Maternal Mental Health Needs to Count

 has featured cover stories providing expert perspectives on multiple important psychiatric issues such as the state of mental health care in the United States, the link between COVID-19 and psychosis, and the future of psychiatry. Halfway through 2022, here are some highlights from this year’s cover stories so far.

Psychosis in the Patient With COVID-19: An Emerging Psychopathology?

The link between viral infections and effects on the central nervous system has been studied with viruses such as influenza, H1N1, and previous coronaviruses, including SARS and MERS. It has been documented that like COVID-19, these viruses have been able to produce symptoms of psychosis in patients with no prior psychiatric conditions.

Recently published studies have shown that COVID-19 can cause severe neuropsychological stress-inducing psychosis in affected patients.

 The literature covering correlations between COVID-19 and psychosis has demonstrated that there has been an increase in the rate of psychotic symptoms such as paranoia, delusions of persecution, and auditory and visual hallucinations in populations with high incidence rates of COVID-19 infection.

Thought, CircRNAs, and a Neurodigital Hypothesis

If you ask a cardiologist, “Physiologically speaking, what is a heartbeat?” they can bore you to tears with details on anatomy, electrophysiology, hemodynamics, innervation, and pulmonary and peripheral circulation. But if you ask a psychiatrist the entirely pertinent question, “Physiologically speaking, what is a thought?” the truth is, we have been without a clue—until now.

Of all psychiatry’s mysteries, this is the most crucial void in our scientific knowledge: how the brain executes the higher functions that are the actual focus of psychiatric practice—the generation of thought and behavior. This knowledge gap has been responsible for psychiatry’s own split personality—historically swinging back and forth between a biological focus on the brain and a psychological focus on the mind. Just as physics sought a unified “theory of everything” to incorporate the mystery of gravity, this missing piece of science has eluded psychiatry since its inception. 

Psychiatric Care in the US: Are We Facing a Crisis?

By the end of 2021, many American adults found themselves in the worst mental state in years. According to the US Census Bureau’s Household Pulse Survey, 47% of adults reported symptoms of anxiety,

 and 1 in 5 adults disclosed suffering from a mental illness.

 Despite this, it is estimated that less than half of Americans with a mental disorder get adequate treatment.

“It has been just over a year now since the COVID-19 pandemic struck the United States full force. A year of hunkering down and Zooming in, teleworking and telepsychiatry, economic and social upheaval, and steady scientific progress. Looking back to last March, we knew this would be difficult. But we didn’t know how difficult. And we certainly didn’t know that the challenge of COVID-19 would last this long,” said Joshua A. Gordon, MD, PhD, director of the National Institute of Mental Health, in a 2021 director’s message.

Psychedelics and the Future of Psychiatry

Over the past several years, we have witnessed a psychedelic renaissance, and a growing body of evidence suggests that several psychedelic compounds hold strong therapeutic potential for a wide array of mental health conditions.

Once dismissed as dangerous and having little therapeutic potential, psychedelic drugs are gaining mainstream acceptance. Research data continue to demonstrate that, on the whole, these medicines are not only safe, but mostly well tolerated. Although more research is needed to better understand safety, especially in the context of at-risk conditions, these favorable safety profiles are enabling deeper exploration of these medicines. 

See more 2022 cover stories and download complete issues of 

. And be sure to stay up-to-date by subscribing to the 

Do you have a comment on any of these or other articles? Have a good idea for an article and want to write? Interested in sharing your perspectives? Write to us at 

Over the past 6 months, Psychiatric Times has featured expert opinions on important psychiatric issues from psychosis to psychedelics.