The first, from the New York Times Magazine is an essay, Mind Over Meds, by a noted psychiatrist who was forced to rethink his approach to treatment, which has been heavily influenced by a growing trend in the psychiatric community that emphasizes drug therapy over psychotherapy/counseling. On Monday, May 10th, at 1:00 pm, Paul Rosenberg, MD, a psychiatrist affiliated with Morristown Memorial Hospital, will be speaking on “The Role of the Psychiatrist: How to Know When One is Needed”. It wil lbe interesting to hear his thoughts on this trend and to find out whether he, too, has felt pressure by managed care to shorten his visits with patients and to prescribe more anti-psychotic medication.
The second article Feeling Warehoused in Army’s Trauma Care Units: GIs Depict Life of Pills and Isolation, relates to the Mental Health Week presentation, “Time and Again: Reliving Trauma”, which will feature talks by Corporal Justen Townsend of the US Marines and Stefan Neustadter, MSW, LCSW, who has worked with military veterans for more than 30 years. Brenda Forte, LCSW, a specialist in the most current treatments for trauma, is also part of the presentation which is scheduled for Wednesday, May 12, at 1:00 pm. The article offers a disturbing portrait of the Warrior Transition Battalion in Colorado Springs, where, again, the emphasis appears to be on prescribing medication rather than providing needed support and counseling.
In the first article, Daniel Carlatt writes:
over the course of the decade following my residency, my way of thinking about patients had veered away from psychological curiosity. Instead, I had come to focus on symptoms, as if they were objective medical findings, much the way internists view blood-pressure readings or potassium levels. Psychiatry, for me and many of my colleagues, had become a process of corralling patients’ symptoms into labels and finding a drug to match.
Leon Eisenberg, an early pioneer in psychopharmacology at Harvard, once made the notable historical observation that “in the first half of the 20th century, American psychiatry was virtually ‘brainless.’ . . . In the second half of the 20th century, psychiatry became virtually ‘mindless.’ ”
Forces [other than modern Psychiatric training] are at work as well. Insurance companies typically encourage short medication visits by paying nearly as much for a 20-minute medication visit as for 50 minutes of therapy. And patients themselves vote with their feet by frequently choosing to see psychopharmacologists rather than therapists. Weekly therapy takes time and is arduous work. If a daily pill can cure depression and anxiety just as reliably, why not choose this option?
In studies by Helen Mayberg, a professor of psychiatric neurology at Emory University, depressed patients given cognitive behavior therapy showed decreased activity in the frontal lobe, the brain center that might be responsible for the overmagnification of life’s problems that leads to depression in some patients. And they showed increased brain activity in parts of the limbic system, a brain region associated with strong emotion. But Mayberg found that when patients were given medication, their brain activities changed in the opposite direction, stimulating the frontal lobe and damping down the limbic system. “Our imaging results suggest that you can correct the depression network along a variety of pathways,” she said.
