Dr. Douglas Berger Replies to Reddit.com Posts

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Scope of Service

We would like to continue to clarify issues about our service. To emphasize our first comment, we did not sue patients or ex-patients. We only sued a minority of anonymous redditors who made defamatory, harassing, and farcical statements about myself and my practice. Again, we are pro-free speech as protected by law. The law also protects the rights of those attacked by outright false and derogatory statements to seek available and appropriate relief through the legal process. The Reddit Content Policy itself also prohibits harassment and bullying that is the community the reddit posters agreed to join.

As a number of posters have noted, the vitriol of many of the posts are far above the usual negative reviews one can see on-line so that the threads are clearly a type of cyber-harassment and cyber-bullying on reddit. Statements with descriptors about myself like: “fucking maniac”;“piece of shit”;“gives patients the creeps”;“scam artist with a doctorate”;“cast-iron racist”;“a charlatan”and other similar statements makes it clear that the discussion has malicious intent over and above being a review. Reddit has a long history of being used as a platform to harass individuals.

This comment will focus on our scope of service. The Meguro Counseling Center is a legally run counseling/consultation service, it is not a medical clinic, nowhere states that it is, and clearly states it is not. It is legally able to consult, counsel, and provide psychotherapy to anyone, and we are legally able to refer clients to a licensed Japanese physician and give any kind of information to these physicians about the referred client. I have Japanese permanent residency and am legally permitted to work freely in Japan. All persons in our service that also receive medications only receive them from a fully Japan-licensed MD who has passed the Japanese medical license test.

To restate from our prior post and other redditors’ searches and posts, I am, 1.) an American Board Certified Psychiatrist, and 2.) I have a Ph.D. from Tokyo University for a dissertation presented to the Department of Psychiatry while a researcher in the Department of Psychosomatic Medicine at Tokyo University.

I am a graduate of New York Medical College, I completed an accredited residency in psychiatry at New York Medical College, and I passed the National Board of Medical Examiners U.S. national medical exam. I then completed a Fellowship in Consultation Psychiatry (now called Psychosomatic Medicine), at the Albert Einstein College of Medicine and became an Assistant Professor of Psychiatry at Einstein. When living in New York, I had active state medical licenses in New York State and Connecticut that were and are in good standing. I still have a Medical License in the State of Nevada. It is still registered, but status is inactive because I needed to practice in Nevada at least once every two years to keep it active, and I have been full-time in Japan for many years. When I wish to practice medicine in Nevada, I can start the reactivation process. A US state medical license does not allow one to practice medicine in Japan, nor does not having one disallow one to do counseling/consulting in Japan. The original of these and other certificates and diplomas can be seen in this index.

Getting, back to the scope of service, any persons we may refer to a medical clinic must register as a patient at this clinic as any patient must. We refer to Internists (“GPs”) as well as psychiatrists. These clinics are all legally allowed to prescribe psychotropic medications to their patients. In contrast to the view of one redditor that a GP (general practitioner MD) prescribing psychiatric medications is an issue, note that a large volume of psychiatric medications prescribed in Japan-and most Western countries- are legally given by GPs, not psychiatrists. This is a good reference for the U.S. where the majority of psychotropics are given by non-psychiatrists: of 472 million prescriptions for psychotropic medications, 59% were written by general practitioners: psychiatryonine.org (the reference is 10 years old but still a valid break-down). For japan, see p. 96 in this document , where it says in-patient psychiatric patients who had psychotropics prescribed by internists or GPs before admission are common (a more detailed percent breakdown probably requires a detailed investigation from a marketing company like IMS which I don’t have).

We can legally refer to a GP, but we also refer to psychiatrists who are willing to see complicated cases, and there are a few medications that usually only psychiatrists can prescribe, although a GP can apply for these prescribing rights if they want to go thru the paperwork, and some have. One redditor posted this link on medications stating that it did not bode well for me. However, this link is about the regulations for pharmaceutical companies doing clinical trials, it has nothing to do with a counseling center, and nothing to do with a licensed medical doctor, including a GP, who can legally prescribe psychiatric medications in their clinic. Either the poster didn't read the document carefully, doesn't understand what the document says, or just posts the document for the effect of criticizing our service.

Our gathering data about a clients, especially English-only speaking clients, and providing information to a clinic we can refer to is a significant help to these persons to bridge some language and cultural gap between patients and doctors, and a legally legitimate part of our service. For persons who need medication in addition to psychotherapy, providing initial and follow up information to the clinics helps create a 3-step safety net for information on medication usage and side-effects (3 steps of: therapist, clinic, pharmacy). We do not directly practice medicine and that fact is noted on all of our web sites in multiple places.

Calling persons who visit these medical clinics "patients" is clearly both legal and appropriate. Most all counseling centers we know of in Japan, local or foreign, also refer clients to clinics for psychiatric medications. How much information a counselor wishes to give a clinic is up to the discretion of what that counselor feels comfortable with, it's referral information to a medical doctor, not medical care. Criticisms of this aspect of our service seem to be trying to incite some kind of suspicion.

I certainly encourage all to exercise their right to free speech, I also urge everyone to do so responsibly, within the confines of the law. These same rights and responsibilities of freedoms apply to myself, to redditors, and to anyone who wishes to enjoy living in our modern free society.

Douglas Berger, M.D., Ph.D., U.S. Board-Certified Psychiatrist in Tokyo

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The Meguro Counseling Center consists of Western-trained therapists able to provide face-to-face mental-health care for the international community in Tokyo. With extensive experience in Japan, these therapists have a deep understanding of the stresses of living in Japan.