Friday, April 19, 2013

Challenges of Psychiatry Blogging: Content

Some of my favorite blogs written by psychiatrists are no longer being updated; of course, this happens all the time on the internet. But starting a new blog has made me think more about the challenges involved in maintaining a "psychiatry blog," what it was that I liked about certain blogs, and what I'm hoping to do with this one. Thus, in this series of posts I will look at some of the different aspects of blogs written by various psychiatrists, and hopefully conclude with some lessons for my own blog.

Of course, the most important aspect of any blog is its content. As psychiatrists, we are privy to the most treasured memories and darkest secrets our patients, not to mention the full range of human emotional expression. My very favorite psychiatry blogs in the past have been ones focussing on stories of interactions with patients. This kind of blogging poses a special challenge, since we must protect the privacy of our patients, so these stories usually have names and other identifying details changed. My favorite blogs of this type have been Roger Lewin and pontificatrix's blog, and sadly neither have been updated in years (I have more to say on blog longevity in another post).

The most important blogs, in my mind, are the somewhat anti-establishment blogs that focus on hot-button issues in psychiatry, which over the last decade have mainly revolved around the relationship of academic "key opinion leaders" to big pharma, over-medicalization and over-medication, and the quagmire of the DSM-5. The very best blog of this genre has been The Carlat Psychiatry Blog, which had a very successful run from 2007 to 2012. It was so successful that Dr. Carlat has gone on to bigger and better things. Recently, the mantle seems to have been taken up by Dr. Nardo at 1 Boring Old Man, and I believe his blog has become vastly more interesting since he started to focus with passion on these topics. Thought Broadcast, though less focused, has a similar independent spirit, along with a level of thoughtfulness that is very appealing.

There are the psychiatrists who cover general topics for psychiatric publications, such as the Psychiatric Times blog. I don't tend to read these, because it makes me feel like I'm doing work. Well, actually I sometimes do read these when I'm at work, so that I feel like I'm doing work. Joking aside, these blogs are useful vehicles for fostering debate within the profession.

Then there's always cultural criticism from a psychiatric perspective, of which The Last Psychiatrist is the exemplar, with his messages of "you are being lied to, by yourself," and "you cannot escape the system." I think I understand, but now I will move on so I don't think about those things too much.

And of course, there are the more generalist blogs that cover anything and everything related to psychiatry. Shrink Rap is one of the earliest and most successful, spawning a book of the same name. I used to read it daily, and I greatly admire the consist productivity of the authors in their postings. I eventually cut back because the blog felt a bit unfocused to me. Plus, the design of the blog feels way too busy. I think The Amazing World of Psychiatry used to cover mainstream psychiatry topics, but the main articles have grown so esoteric that I rarely read them these days. However, Dr. Marley still provides links to interesting articles that he has come across, which remains a valuable service. My favorite general psychiatry blog in the last few years was Peter Kramer's In Practice blog, which was active mainly from 2008 to 2009. Dr. Kramer has a history of being a successful author, publishing several books, and I think his writing skill contributed greatly to this blog's appeal. No matter what he write about, I found myself reading the article and feeling more informed afterwards.

Closely related to content of blogs are the "voice" of the bloggers. The blogs I seem to like best are the ones written by a single individual, rather than an amalgamation of different voices. They seem to have more of a personality and perspective, which makes repeated viewings more interesting and encourages conversation with the blogger via the comments system.

In my next post, I will discuss the challenges related to the audience of a psychiatry blog.