There’s an interesting article on the New York Times website: Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy (March 5, 2011).
The essence of the article is that psychiatrists no longer engage in talk therapy to any great extent, but instead prescribe behavior-altering drugs.
What’s interesting about this is that the author, Gardiner Harris, seems almost surprised at this “discovery.” In fact, the change from talk to pills occurred decades ago – during the 70’s I would say, and was more or less complete by 1980.
There are some interesting passages in the article, which focuses on the work of a Pennsylvania psychiatrist, Donald Levin.
Then, like many psychiatrists, he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. Then, he knew his patients’ inner lives better than he knew his wife’s; now, he often cannot remember their names. Then, his goal was to help his patients become happy and fulfilled; now, it is just to keep them functional.
“I’m good at it,” Dr. Levin went on, “but there’s not a lot to master in medications.”
A psychiatrist can earn $150 for three 15-minute medication visits compared with $90 for a 45-minute talk therapy session.
In 2009, the median annual compensation for psychiatrists was about $191,000, according to surveys by a medical trade group.
“You have to have a diagnosis to get paid,” he said with a shrug. “I play the game.”
“I don’t need a half-hour or an hour to talk,” said a stone mason who has panic attacks and depression and is prescribed an antidepressant. “Just give me some medication, and that’s it. I’m O.K.”
“The sad thing is that I’m very important to them, but I barely know them,” he said. “I feel shame about that, but that’s probably because I was trained in a different era.”
So, as I have said on this blog many times, psychiatry today is drug-pushing. Psychiatrists sell prescription slips for about $50 each. The drugs involved are not medication – they are drugs, the function of which is to alter people’s behavior and mood. There have been some interesting responses to the Gardiner Harris article.
Daniel Carlat, psychiatrist, author of the blog post Dr. Levin, Modern Psychiatrist – Unfulfilled, Bored – But Wealthy comments that since the introduction of the drugs “psychiatrists no longer needed to do therapy to make good money.”
He also notes that:
“Many psychiatrists will recognize the sense of tedium and boredom described by Dr. Levin. He went through psychiatric training to do therapy and is now a pill-pusher.”
If you’ve read Daniel Carlat’s book Unhinged I think you will find him refreshingly honest, although he clings (almost desperately) to the notion that psychiatry is a helping profession and that the drugs are administered to treat illness. If he ever gets truly honest, however, he will have to find honest work – and that’s daunting.
Another comment, from Christopher Lane, author of the blog post I’m Not Your Therapist, But I Could Adjust Your Medications:
The power of the article lies less in stating what’s already well-known about American psychiatry—that it favors drug treatments over talk therapy, despite growing evidence that the latter strongly outweighs the former in terms of efficacy and freedom from side effects. The article’s power lies instead in tracking the myriad decisions that Drs. Levin and Lance make on an ordinary day full of appointments with dozens of suffering Americans.
And so it goes. It’s good that the article was written and that it has received a great deal of attention. The widespread medicalization of human problems for profit is a destructive rot within our society, and anything that draws attention to the drug-pushing nature of psychiatry is helpful. Depression, anxiety, anger, misbehavior, crazy speech – these are not illnesses. They are human problems. They can be masked by drugs. But as any recovered addict can tell you – drugs are not the answer to life’s difficulties.
