What’s Wrong With This Picture? Psychiatrists’ Focus on Drugs and Emotional Distance: by Paula Caplan

This New York Times article “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy” was shared and commented on the other day by Gianna here on Beyond Meds. Today we share Paula Caplan’s pointed concerns from her blog, “When Johnny and Jane come Marching home.”

Below is an excerpt of Caplan’s piece:

What’s Wrong With This Picture? Psychiatrists’ Focus on Drugs and Emotional Distance

In Sunday’s blog, “The Astonishing Power of Listening,” I undertook to write a second part of that blog and said that it would be about the March 6 New York Times front-page article headlined “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy.”[1] Gardiner Harris, the journalist who wrote that story, is smart and has done brave and important work in exposing other serious problems in the mental health system.

Because this blog appears on the website for my forthcoming book about war veterans, please keep in mind that every concern raised here goes double for vets. This is both because the fact that war has shocked and devastated them is often wrongly labeled “proof” that they are mentally ill and because in the military and the VA systems, they are increasingly likely to be loaded with psychiatric drugs.

It is worth taking a look at some of the important and troubling information Harris provides in his latest piece, as well as at some serious problems with the way it is written. It is possible that the problems result from an editor’s changes rather than from the writer himself, especially given Harris’s sterling history.

Harris tells much of the story indicated in the headline through the experiences of Dr. Donald Levin, a 68-year-old psychiatrist who used to do a lot of “talk therapy” and currently does nothing but prescribe psychiatric drugs to patients. When patients come to him and start to talk about heartbreaking, real life problems, he sends them away, saying he is not their therapist. Was it brave of Levin to acknowledge this practice publicly? Or is he so out of touch with some of the most basic ways of being human and being in one of the “helping professions” that he doesn’t even know how he sounds? Is our society so structured, even overwhelmed by the medicalizing of human problems that even a longtime psychiatric practitioner thinks at some level that this approach is acceptable? Harris quotes Levin as saying, “I had to train myself not to get too interested in [my patients’] problems.” Would you see a psychiatrist if he told you that was his attitude?

Levin says he feels shame that some of his patients say he is important to them, when he barely knows them. How troubling and revealing that he attributes that shame not to healthy causes but to the fact that he “was trained in a different era.” And in our era, there are plenty of colleagues who will tell him that his shame (and maybe his own missing of deeper human connections with his patients?) is unprofessional, even neurotic.

Levin’s current practice of treating “1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart,” in contrast to his practice in 1972 of treating “50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each” does not set him apart from most psychiatrists. Harris tells us that in 2005 a government survey revealed that only “11 percent of psychiatrists provided talk therapy to all patients, a share that had been falling for years and has most likely fallen more since. Psychiatric hospitals that once offered patients months of talk therapy now discharge them within days with only pills.”

Some of the most disturbing features of this article are statements presented with no journalistic balance, no comments from people with other views. The statements purvey the notion that prescribing psychiatric drugs is mechanical, simple, and effective. Well, mechanical it certainly often is in the sense that it is often done without much heart, but it is not mechanical in the sense that it is easy to know what medication will have what effects, both positive and negative. Yet Levin’s statement that in his current work he is “like a good Volkswagen mechanic” goes unquestioned… read the rest here

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