Off Script, unfiltered.
Essays and observations from working clinicians. Mental health, broader than a diagnosis.
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Jump to what you came for, instead of scrolling. 12 topics, each linking to every essay tagged with it.
AI girlfriends and male loneliness
The number of guys using Replika, Character.ai, and the half-dozen newer AI companion apps has gone vertical in the last couple of years, and it’s showing up in…
Jul 8, 2025
Decline of male friendship after 40
The data on this is what it sounds like.
Jul 5, 2025
Jonathan Haidt’s Anxious Generation: what’s right and overstated
Haidt’s argument in The Anxious Generation is that smartphones and social media, hitting kids hard around 2012, broke teen mental health. The data on adolescent depression and anxiety…
Jul 3, 2025
PCP-psychiatrist handoff: when to switch
A lot of the psychiatric medication in this country is prescribed by primary care doctors, not psychiatrists.
Jun 30, 2025
Mental health records: background checks, gun ownership, licensure
This is one of the questions that comes up in the first appointment most often, particularly from guys who own firearms or work in jobs with security…
Jun 27, 2025
Off-label prescribing: what it means
A huge percentage of what psychiatrists prescribe is off-label, and most patients have no idea, which is its own problem.
Jun 25, 2025
Long-term med use realities (20-year horizons)
The honest answer to "can I stay on this medication for the rest of my life" is: we don't fully know what happens at 30 or 40 years out, because…
Jun 22, 2025
Antidepressant withdrawal vs relapse: distinguishing
Guys stop their antidepressant, feel terrible a couple weeks later, assume the depression is back, restart the medication. Sometimes that's right.
Jun 20, 2025
Why some clinicians won’t take insurance
I take insurance. A lot of psychiatrists in private practice don't.
Jun 17, 2025
Freedom Costs Blood. Mental Health Costs Choices.
Freedom isn’t free. Neither is good mental health.
Jun 13, 2025
The Story I’m Telling Myself Is…
Most people don't get taken out by facts first. They get taken out by what the facts start to mean. You send a text and don't hear back.
Jun 11, 2025
Expectations Hurt Us More Than People Do
A lot of disappointment starts long before anyone actually does anything wrong. It starts in the quiet little contract we made in our own head.
Jun 8, 2025