Daniel Reyes 
When Marcella, a 34-year-old Diné mother of three living on the Navajo Nation outside Shiprock, New Mexico, started waking up at 3 a.m. with chest-crushing panic attacks, she did what her grandmother told her to do. She drove the 41 miles to the nearest IHS facility. The intake clerk was kind. The waiting room was … Read more
Carla worked the late shift at a corner pharmacy in Camden, New Jersey, the kind of neighbourhood where the medical examiner’s van had become a familiar sight. On a Thursday in March, an older woman walked up to the counter holding a creased printout from a community group. She was 68, her name was Beverly, … Read more
Tomas from Houston had been on three different antidepressants over two years, with each one producing partial response and intolerable side effects in some combination. His psychiatrist, before adding a fourth agent, took an unusual side road. She prescribed pharmaceutical-grade ethyl-EPA fish oil at two grams daily, alongside the existing medication, and asked him to … Read more
Marisol was nineteen, a sophomore at the University of Denver, when her residence director found her unconscious on the bathroom floor. Her roommate had called twice that week, worried. Marisol had stopped going to the dining hall in November. By February, she weighed 78 pounds. The paramedics noted a heart rate of 32 beats per … Read more
The Question You Have Been Afraid to Ask You drink to calm your anxiety. Three beers and the racing thoughts slow down. A glass of wine and the tightness in your chest loosens. The alcohol works. That is the problem. It works so well that you have started to depend on it. Now you wake … Read more
Rachel, a 38-year-old graphic designer in Portland, Oregon, came home from the emergency veterinary clinic on a Wednesday night without her cat. Mochi had been with her for fourteen years, longer than any romantic relationship, longer than any apartment, longer than any job. Rachel cried so hard in the parking lot that the vet tech … Read more
Hannah Quigley washed her hands until they bled. The 27-year-old graphic designer from Saint Paul had developed contamination OCD after a hospital stay in 2022, and by spring 2025 she was spending 11 hours a day on rituals: showering 90 minutes, scrubbing doorknobs with bleach. Her outpatient ERP therapist tried for nine months. Her psychiatrist … Read more
The Discharge Most Patients Are Not Ready For The American psychiatric emergency department is a remarkable but limited intervention. It can keep a person alive through a crisis, run urgent labs and toxicology, restart medications, and sometimes negotiate an inpatient admission. What it cannot do is provide the kind of continuous mental health care a recovering patient … Read more
Marcus was twenty-one years old, a junior at the University of Cincinnati studying mechanical engineering, when his roommate noticed him whispering to a corner of their dorm room at three in the morning. Within six weeks, Marcus had stopped attending classes, accused his mother of poisoning the family dog, and barricaded himself in his bedroom … Read more
A Real Day in an Intensive Outpatient Program People hear the words “intensive outpatient program” and picture something between rehab and weekly therapy without a clear sense of what actually happens during the program day. The vagueness keeps many patients from accepting a step-up referral when their mental health care needs more than standard outpatient can deliver. … Read more