Brainless, Then Mindless
The New York Times Sunday magazine section of April 25, 2010, ran an article written by psychiatrist, Dr. Daniel Carlat, entitled, "Mind Over Meds." The doctor discusses the fact that through his practice, he discovered that medication alone was not enough for his patients. They wanted more from him, including the opportunity to talk about their problems. Dr. Carlat goes on to lament the fact that psychiatry abandoned psychotherapy in favor of treatment with medications. The work of psychotherapy was turned over to clinical social workers and clinical psychologists.
In briefly summarizing the history of psychiatry, Dr. Carlat points out that in the 1st half of the 20th century psychiatry focused on the mind and on psychoanalysis. In the 2nd half of the 20th century and into the 21st, psychiatry abandoned the mind in favor of treating the brain. In other words, he states that psychiatry went from being "brainless" to being "mindless." He now focuses more attention on providing psychotherapy for his patients in addition to medication.
He goes on to explain that part of the reason for the shift away from psychotherapy had to do with pressure from insurance companies to get quicker and less costly results. In addition, psychoanalysis fell out of favor. Instead, attention was devoted to cognitive behavioral therapy in addition to medication.
What is so interesting about this article and what makes it so timely is that recent research has demonstrated the effectiveness of psychoanalysis as a treatment for psychological disorders. In fact, some of the research shows that psychoanalysis is superior to cognitive behavioral therapy, because it goes deeper.
Dr. Carlat correctly points out that it takes time to really get to know patients and that relying on medication to treat symptoms alone is not fair to them.
In my experience, I have worked with two types of psychiatrists. One is the type of doctor who strictly prescribes medication and refers the patient to me for psychotherapy. At best, this type of psychiatrist spends about 20 minutes with the patient, and then consults with me as the therapist, if necessary. The other type of psychiatrist with whom I've worked is also a psychotherapist. He spends much more time with each patient and consults with me on the psychotherapeutic process of the patient. Generally speaking, this psychiatrist refers to me, because his fees are too expensive for the patient.
It seems to me that it is time to get back in touch with both the minds and the brains of our patients. Whether medication, cognitive behavioral therapy or psychoanalysis is being used, we need to be in touch with the whole patient.
What are your experiences with psychiatrists and psychotherapists? Your comments and questions are encouraged.
Allan and Schwartz, PhD
Research on Psychoanalysis vs CBT - Michael Anestis - Mar 7th 2011
Just a quick comment. The research that supposedly demonstrated that psychoanalysis is equivalent to or even superior to CBT is, unfortunately, filled with overwhelming flaws.
Recent publications in Psychotherapy and Psychosomatics (e.g., Bhar et al., 2010) and the American Psychologist (e.g., Anestis, Anestis, & Lilienfeld, 2011) directy address the flaws in the work of Shedler, Leichsenring, and others.
I have summarized much of this work on Psychotherapy Brown Bag:
Treating Body, Mind & Spirit - Terry McLeod - May 4th 2010
Insurance companies are evil.
That’s the feeling I get whenever I write a check for a premium. I get that feeling when I’m denied payment for a medication because it’s out of formulary or the co-pay goes up. Insurance companies encourage fast-food treatment for what can be lifelong difficulties…when we take that approach with nutrition, we end up obese. When we take that approach with behavioral/mental health and addiction/alcohol problems prescribing only medication as the answer, we can end up as zombies with mind-problems that are hidden and never resolved, or chronic conditions that we don’t learn how to live with.
Twenty years ago I was a privileged patient of a psychotherapist in Ashland, Oregon. At the time, I was having some trouble with life that was rooted in low self-esteem. I couldn’t pay the bills no matter what my income; everything I did seemed somehow wrong. I attended individual therapy and a men’s group and also joined a self-help group, and over the course of years I made significant changes that affected my larger future. I also started meditating. In short, a combination of therapeutic, behavioral and spiritual efforts worked.
By the way, I’m not a Christian, Buddhist, Hindu, Moslem or a devotee of any religion…I just meditate regularly. It works for me.
Since then, I temporarily added medication into the mix for some anxiety I was experiencing after a heart attack, along with individual therapy and self-help. The medication worked. I no longer need it or take it, and I don’t participate in individual therapy, it worked, too.
Today, I have a good life, and a holistic approach to treating the body, mind and spirit is integrated into that life. Others can and do find this successful, too.
A friend of mine recently couldn’t get the medication mix right for his depression. It took day-treatment to get him on track. Now his medication is right, he made some behavioral changes and it worked…depression faded away.
There’s too much evidence around me about what works to ignore it.
Insurance companies exist to make money. Wendell Potter (http://www.prwatch.org/cmd/bios.php/Wendell_Potter) is watching them, but still, they will demand fast-food treatment because it’s cheaper for them. Effective treatment takes time and a combination of efforts targeted toward body, mind and spirit.
The patient has to want to get better, and that’s an inside job. From what I’ve seen, it’s usually a patient choice to recover by taking the tough road.He has to do what it takes to recover, body, mind and spirit…or just take drugs and even though the patient doesn’t realize it, be slowly changed into a different person.
Professional disconect very frustrating - Victoria - May 3rd 2010
I find this very interesting. I think one thing that is sorely missing is comprehensive treatment for people who are dealing with psychiatric issues. It seams to me, that people who are also diagnosed with certain things such as eating disorders, other addictions and diseases such as Schizophrenia might receive more comprehsnive treatment, but people dealing with depression, or anxiety disorders don't always, when these diseases destroy peoples lives just as easily as the afore mentioned ones. One thing that I really do not understand is how anyone on psychiatric medication can even be on the medication (if on it for psychiatric reasons) without being seen by a therapist. For those individuals who do see both a psychiatrist and a therapist often times the two professionals never even have a phone conversation. This is only exacerbated if a patient ends up in the hospital. In the hospital things get more complicated because medications get changed, people see a therapist of some kind but then their outpatient treatment team never gets notified. Not sure how this can change, but if insurance companies really wanted to save money they would focus on prevention. Focus on long term treatment instead of 2 night hospital stays. Focus on long term therapy instead of only covering 10 sessions for a patient. Just my thoughts.