I read a good article in the NYT the other day (thanks again, Kyle) dealing with the state of psychiatry in the USA. Over the years, psychiatrists have become known more for clinical interviews, diagnosis, and prescribing medication than for doing actual therapy with their patients. Daniel Carlat, M.D., a psychiatrist and the author of this article, tackles several topics over the course of the article: medication vs. therapy, the evolution of psychiatry, placebo vs. non-placebo treatment, and his own struggle of how much therapy to provide as a psychiatrist specializing in psychopharmacology.
I’ve been wrestling with my reactions to this piece for some time now. My initial reaction was one of disdain. “Of course you should be doing more therapy,” I thought. “How could psychiatrists ever think medication is all that’s necessary to help people better.” To understand this reaction, you have to understand the long-running “feud” between the fields of psychiatry and psychology. The prevailing attitude, as far as I understand it, is that psychologists think psychiatrists are overpaid and mechanical, while psychiatrists consider psychologists pseudo-professionals practicing a soft science on par with a sugar pill in terms of effectiveness. I’m generalizing, of course, but you get the idea.
Back to my reactions. After I sat with my knee-jerk feelings and let them settle down a bit, other thoughts came. Like what would happen to psychologists like myself should psychiatrists become the one-stop shop for therapy and medication. Would we become obsolete? Again, a defensive reaction based in fear. I sat a little more and became aware of a more open attitude that’s stuck with me since – that, more than anything, I’m just pleased to see a potential shift in psychiatry that might allow individuals to get better treatment for what’s bothering them. Research has long shown that talk therapy plus medication is the treatment of choice for many concerns. Rarely is either more effective in isolation. So if psychiatrists can deliver both for clients that need it, good for them.
If you’re interested in reading more, the folks over at Shrink Rap (also psychiatrists) touch on these issues often as well. I’d love to hear others’ opinions on medication vs. therapy – feel free to post any comments below. Thanks for reading,