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