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Depressed? Anxious? Perhaps eating disordered or feeling overwhelmed by the struggles of being a primary caregiver to a critically ill spouse or elderly parent– sometimes a form of post Traumatic Stress Disorder?
Before you make that all-important call to schedule with a psychiatrist consider:
· “…[T]he percentage of visits to psychiatrists that included psychotherapy dropped from 44 percent in 1996-1997 to 28 percent in 2004-2005. And the percentage of psychiatrists who provide psychotherapy at every patient visit decreased from 19 percent to 11 percent. This decline in therapy was closely correlated with the growth of medication treatment and decreasing insurance reimbursements for psychotherapy.
· “Managed care companies discourage [psychiatrists] from doing psychotherapy, arguing that it is more cost effective for psychiatrists to do 15-minute medication visits every 3 months, and to hire a lower paid non-M.D. for more frequent therapy visits.
· “…Over the past two decades, psychiatry has gone astray. We have allowed our treatment decisions to be influenced by the promise of riches from drug companies, rather than by what our patients most need. We have fought pitched turn wars with our colleagues in related disciplines, instead of learning from them and incorporating their effective therapeutic tools into our arsenal. Finally, we have unquestioningly sought to become just as “medical” as other doctors, when we should embrace the fact that psychiatry is remarkably different from the rest of medicine.”
· “As psychiatrists have become enthralled with diagnosis and medication, we have given up the essence of our profession – understanding the mind. We have become obsessed with psychopharmacology and its endless process of tinkering with medications, adjusting dosages, and piling on more medications to treat the side effects of the drugs we started with. We have convinced ourselves that we have developed cures for mental illness…, when in fact we know so little about the underlying neurobiology of their causes that our treatments are often a series of trials and errors.”
· “Whether we are talking about depression, schizophrenia, or bipolar disorder, the new drugs introduced over the past fifty years are no more effective than the original prototypes – such as Haldol for schizophrenia, lithium for bipolar, and nardil for depression. We are keep to prescribe the newest drugs, and patients assume that much progress has been made in psychopharmacology over the past several decades,but… this profess has been overblown…. Even our newer drugs’ supposed advantage – fewer side effects – is being called into question.
· Our diagnostic process is shallow and is based on an elaborate checklist of symptoms, leading us sometimes to over-diagnosis patients with disorders of questionable validity, or, conversely, to miss the underlying problems in our rush to come up with a discrete diagnostic label that will be reimbursed by the insurance company. We tend to treat all psychological problems the same way – with a pill and a few words of encouragement. Because of this rote approach to treatment, patients are often misdiagnosed and medications are overprescribed…We have been seduced by the constant encouragement from drug companies to prescribe more medications and an insurance reimbursement system that discourages therapy… Pulled by both drug companies and consumer demand to provide immediate drug fixes to life’s difficulties, the field of psychiatry has become unhinged, pried away from its original mission – to discover the causes of mental illness and to treat those causes, not merely the symptoms.
In Unhinged: The Trouble With Psychiatry – A Doctor’s Revelations About A Profession In Crisis (Free Press, 2010) Daniel Carlat, MD has produced a scathing indictment of the profession to which he has dedicated fifteen years “in a small town north of Boston.” A member of the faculty of the Tufts Medical School and a solo practitioner, Carlat trained at Harvard Medical School and Massachusetts General Hospital. He is also the editor of The Carlat Psychiatry Report, a monthly newsletter for clinicians in the US.
By his own admission, Carlat experienced a series of epiphanies that caused him to begin questioning his role as a shill for Big Pharma, the validity of many of the “scientific research” and “medical” reports that provide the basis for psychiatrists prescribing practices, and the efficacy of the “15-minute medication session” that is the basis for much of what now passes as as psychiatric “treatment.”
Chapter by chapter, dissects the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders – IV, the bible of psychiatric diagnosis – diagnosis by committee consensus without scientific basis and by checklist; the role of drug reps and so-called “experts” in the PR selling of new drugs to prescribing physicians; sham therapeutic treatments; and the innate weaknesses of contemporary psychiatry – including the loss of clinically proven counseling skills and an almost myopic focus on prescribing psychoactive medications that necessitates more and more prescriptions to offset side effects.
The bottom line is; An MD psychiatrist can earn two, three or four times as much by scheduling 15 minute medication prescribing/reviewing sessions than he can with a 45 or 50 minute hour of psychotherapy.
That’s one of the most critical points made by Daniel Carlat, MD in Unhinged: the Trouble With Psychiatry – A Doctor’s Revelations About A Profession In Crisis (Free Press, 2010).
At The Brain Training Centers of Florida we help people resolve these issues every day. We offer lasting relief without the use of medications. Our Brain Wave Optimization and Cognitive Behavioral approach is noninvasive and extremely quick acting. Please call our office at 305-412-5050 to schedule a consultation.
In 1973, while studying for the Roman Catholic priesthood with the Maryknoll Fathers, I was arrested and held for eleven days as a political prisoner in Latin America. Upon my return to the US, I immediately requested and received counseling from Dr. Thomas Stauffer, an outstanding psychiatrist. To this day, I remain grateful for his assistance and empathic support. Despite the fact today I would be diagnosed with Post Traumatic Stress disorder, I did not request and Dr. Stauffer did not prescribe psychoactive medications.
Nonetheless, as a result of my work with him, I greatly appreciate the role of the well-trained and highly competent psychiatrist. When appropriate, I refer clients for assessment and medication. I also encourage clients to work closely with their prescribing psychiatrists and, as quickly as possible and if possible, withdraw from medication – if that is consistent with their desires and their on-going progress.
Francis J. (Skip) Flynn, Psy. D.