Leon Eisenberg, a pioneer in psychopharmacology at Harvard, observed 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.’ ” The brainless period, in his view, was the when psychiatry centered on psychoanalysis; the mindless period, is our current state of affairs, where pills are offered more often than therapy.
Unhinged: the Trouble With Psychiatry by Daniel Carlat M.D. is the partial confessional of a pill-pusher. With admirable candor, Carlat, a psychopharmacologist who is now a professor at Tufts University School of Medicine, describes many years in which a typical client session consisted of deciding - through rapid-fire questioning over 15 minutes - which of the labels from DSM-IV, the manual of American psychiatry, best applied to a patient, and then writing a prescription for the drugs recommended for that condition. "Psychiatry, for me and many of my colleagues, had become a process of corralling patients’ symptoms into labels and finding a drug to match."
-
-
While drugs relieved the symptoms of depression in 40 percent of patients, he notes that placebos lift depression in nearly as many - 30 percent. Carlat came to realize that he knew almost nothing about most of his patients. He was shocked into starting to look at his patients as moe than DSM tags when one of them asked him whether it was possible that her childhood experiences had something to do with her current mental and emotional suffering. Carlat's recommendations are modest: let's have some talk, as well as the pills. Let's try to put the patient's symptoms in a context and offer some emotional support and help with problem-solving.
-
-
Carlat brings out something we need to know, in the thick of the current debate over health insurance options. "Insurance companies typically encourage short medication visits by paying nearly as much for a 20-minute medication visit as for 50 minutes of therapy." For both the insurance companies and uninformed patients, quick-fix meds may seem preferable to a series of therapy sessions. But as Carlat came to appreciate, "the majority of patients need more."
-
-
Medication may be essential to contain a crisis situation, threatening suicide or a psychotic outbreak. But the reflexive move to suppress the symptoms of dis-ease by medication misses a vital avenue of healing. Through the creative imagination, we can work with any image - even the most terrifying - towards wholeness and integration. When we reach for a bottle of pills to drive a troubled person's images (be they fantasies, dreams or nightmares) out of their conscious minds, we may be smothering their own source of authentic healing. Through the practice of Active Dreaming, we learn to go into the forests of the mind and confront and resolve whatever terrors wait for us there. We discover that very often the deepest healing comes through the wound. Therapists can learn to use these techniques to guide others to safe clearings. But that will require more than 15 minutes and a prescription pad.
