Unhinged will not be officially released until May 18, but for a preview, read my article, “Mind over Meds,” in this Sunday’s New York Times Magazine. In the article, I focus on one of the topics covered in Unhinged—namely, the abandonment of psychological mindedness by psychiatrists. When I went into psychiatry, I did so because I was fascinated by the mind. But what I encountered during training was a field that was hypnotized by the idea that psychiatry is primarily a medical, rather than a psychological specialty. Rather than understanding people, the goal of psychiatry had become diagnosing disorders, and matching disorders up with medications to treat symptoms. I had assumed I would become a psychotherapist who also prescribed medications when needed. Instead, I was trained to become a psychopharmacologist. When a patient needed therapy, I learned how to figure which therapist to refer the patient to, rather than how to actually do that therapy. I believe this is one of the central crises facing psychiatry today.
If you see a psychiatrist, ask yourself whether he or she really understands you as a person. Does your psychiatrist know what makes you tick? How much have you learned about yourself, about your needs, your goals, and how to attain happiness? Some psychiatrists do, in fact, provide the entire package of medication plus psychotherapy. If you are lucky enough to have found someone like that, you are unusual, because the latest research shows that only 10% of psychiatrists offer therapy to all their patients. Instead, most of us split up the treatment, prescribing medications during 15 to 20 minute visits, and farming the therapy out to a social worker or a psychologist.
It is as though we are splitting our patients into two people. One is a soup of neurotransmitters, and the other is a person. For some patients, this split treatment model works fine, but for many patients it causes fragmentation of care, and that’s not good treatment. As professionals, we can do much better than that.
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I have been seeing a psychiatrist and/or therapist of one kind or another on a regular basis since I was 23 years old and I am 49 now. Back when I first started seeing my first regular psychatrist, he actually talked to me and seemed interested in my life because my life had a direct effect on my mental illness! GO figure! And the more he KNEW me, the better my treatment and then gradually he started cutting the time he spent with me -at first, it was an hour, then 45 minutes, then 30 minutes, then 15 minutes and finally I was lucky to have 5 minutes! HE would just ask me what prescriptions I wanted and I would remind him that HE was the DR, not me and should he not have some say in what he wrote on the script pad; but no; it was what did I WANT. Now, I have bipolar disorder and PTSD and Anxiety and Panic disorder as well as chronic severe pain from a disease I have had since I was 23 also. So I would leave the office with a stack of prescriptions from pain meds and muscle relaxers and antipsychotics, antidepressants, antiaxieties, and just whatever I wanted. So I would study about different meds and decide beforehand what might help me that month and if I wasn’t better after 6 weeks I would ask him to change to this drug! Heck, I had to know what I needed to get the right meds for myself and now I moved away from the part of the country where he was and I found out he was bought off or a “dirty doc” and lost the right to prescribe narcotics and certain other drugs because he had turned his office to a cash only business and five minute visits every three months for everyone – at least this is what I was told! He doesn’t have his practice anymore, so that explains the reason I have not been able to get my medical records for 2 years. I finally quit seeing a psychiatrist because I didn’t trust them due to this fact of feeling like they were just drug dealers – in effect. So now I see my general practicioner and am doing better than I ever did seeing a psychiatrist. Also, I saw a psychologist for several years and he helped me through therapy more than the meds did. Now I live in another state, one that takes care of their mentally ill population more than any other state I have ever been in and now I have a new therapist and she’s female, like me. I just love her because she has helped me more in just 3 months than anyone in 26 years! She ACTIVELY LISTENS. She gave me her email address so that whenever I need to talk to her, I can write to her and although she may not be reading it right then, she does before my appointments and so she keeps up to date on everything I am going through in my life daily and I feel like she is helping me by just letting me vent to her whenever I need to thru the computer and she has tried or offered to try different types of therapy, like EMDR and dialectical therapy and things I have never used before. I feel like I am coping better now because I do not feel like a number of little value. My primary care Dr also LISTENS and doesn’t rush me out even though he is a very busy man. He has devoted his life to help others and he is 60 and one of a dying breed because he DOES CARE! HE does not give me what I want, but what HE thinks I NEED and no more and I really respect that about him. He is VERY careful about the scripts he writes. Anyway, it would be nice if psychiartists would go back to the old way when they were actually our doctors that did the job they were supposed to be doing and there may still be a few out there who do, but I imagine also that they just burn out from dealing with everyone elses problems and med checks are just easier and they can make more money. But we do need more docs who still care and it is not just a job to them but a God-given way of life they dedicated themselves to and they would deserve the reverence doctors used to have way back when they would even come to your home if you were just too sick. How nice would that be?? That’s just my 2 cents worth and I hope nobody was offended by anything I said because I diddn’t mean to. Thank you for letting me make a comment. Debbie Moore
I live in Texas. I have never been to NY, but I read the Sunday Times. Your article “Mind Over Meds” coincided with my birthday, April 25. I saved it.
Last week I posted a photo I took of the title and uploaded it to one of my blogs. I wrote about my wonderful psychiatrist, Dr. Wanda Henao, who finally began talking to me. I have weekly talk sessions with another wonderful woman, Olivia Ostrin. I need something different from both women. The need went beyond the 15 minute med check with Dr. H. She had no idea until I told her. I could tell by the look on her face that it surprised her. But, she was kind enough to understand, and when I need extra time to talk about anything that matters, she gives it. Those extra moments of connection are boosts.
Several days ago I blogged about the extra something I get, because of your article and because of the miracle of Wanda Henao. The next day I deleted it. I was too embarrassed. Now I regret my cowardly reaction. I wish you could have read it. It was my affirmation to you. But thank you for being conscious enough to know that people need more than prescriptions. Thanks for telling your colleagues. Wake them up! It makes more sense for the hour-long (45 min.) listener to know what’s best to prescribe more than the pill pusher. I know from experience.
I just might buy your book.
Thank you.
BC
I am a psyquiatrist in Brasil and i agree with all the Daniel Carlat’s considerations.I buyed the book Unhinged e i am writing a book named “Psyquiatry S.A.”. Daniel Carlat is cited in my book, off course. Congratulations to him.