Back in the seventies and eighties, when analysts ruled the world of psychiatry, the father of all analysts was Sigmund Freud ( even though he died in 1939 ). A logical choice, because he was the man who 1st wrote about the unconscious, the id, ego and superego, and developed the technique called psychoanalysis.
In psychoanalysis, the patient lies on a couch facing away from the analyst, and lets his thoughts wander. One thought leads to another and to another (free association), and after many, many sessions, the patient finally begins to understand and deal with what is really happening in his unconscious. Like a snowman disappearing on a warm winter day, the repressed anger and fear that fueled his anxiety and depression melts, and a new sense of peace and comfort can take its place. This is obviously a simplified version of a very complicated process, but a process that was and is extremely effective.
Back in the day, psychiatric residents fought to get supervision with analysts. Having an analyst teach you the nuances of psychotherapy was an exciting honor.
Psychiatric training programs have dramatically changed. Courses in intensive psychotherapy, which use the principles of psychoanalysis without the need for five times a week therapy for many years, are not nearly as popular. The analytic institutes now train social workers, psychologists and MFTs in addition to a much smaller number of psychiatrists. This sets up the need for split therapy, a psychiatrist prescribing medication and a non-psychiatrist doing the psychotherapy.
Understandably, the old system needed to change because only the rich could afford psychoanalysis, but the way that the focus has shifted from understanding the human mind to balancing neurotransmitters also leaves a lot to be desired.
The principles that Freud discovered won’t just disappear. There will always be an unconscious, and ignoring how it often rules the way we function will most certainly interfere with the effectiveness of psychotropic medication. Without a balanced use of psychotherapy and medication, the patient will suffer.
We are a combination of chemistry and soul. Managed care and budget cuts won’t ever make that go away.
If you enjoy being Inside the Mind of a Psychiatrist, you might also enjoy, The Man with a Microphone in his Ear, Chasing Backwards, a psychological murder mystery, and Skin Dance, a mystery. All are available as paperbacks and eBooks.