World events, a psychological view – Page 45 – Inside The Mind of a Psychiatrist

Since publishing this post last October, and living through the tragedy of Robin Williams suicide, my thoughts seem even more immediate and important. We can’t just watch our wonderful profession sink into mediocrity. Too many people need our expertise…

Once upon a time, psychiatrists spent uncountable hours during their training learning how to do psychotherapy. They studied the vagaries of the unconscious, had intensive training presenting cases to highly trained supervisors, read volumes on how the psychiatric greats treated their patients, and helped train psychologists, social workers, MFTs and other therapists to do therapy.

Then Insurance companies sold the concept of managed care. The mantra was simple. Treat symptoms not people. Don’t take time to understand someone, just take the depression and anxiety away. Time is money. A good psychiatrist is one who doesn’t use time, but fixes things quickly. Medication is the cure. Psychotherapy? Leave it to the other therapists.

Well, the insurance companies did what they set out to do. All the money they were paying psychiatrists (and I can assure you that those fees were nowhere near what surgeons or other specialists made) now went to the middle managers who were paid to limit care. Big business defined what was good psychiatry and what was bad psychiatry.

So what does it all mean? Should psychiatrists be happy prescribing medication and just let other therapists do psychotherapy?

To me, psychiatry is a specialty that is a combination of medicine, psychology and poetry. Only psychiatrists go to medical school and have the opportunity to understand the complete person. The mind and the body always work together. One can’t exist without the other. To just prescribe meds is the equivalent of removing only the top of the iceberg. What about the main part of the person, the part that was formed back in childhood, the part that psychotherapy reaches.

In Brave New World, the dubious answer to human pain was the drug “soma”. We can’t let that happen in our society. Just using drugs because they are a cheaper way to calm the masses and save money is short-sighted and hurtful.

Psychiatrists used to be masters of the mind. They used their unique skills to help all psychological professionals understand what people were all about and how to help them combat the psychological torture that was ruining their lives.

Limiting a psychiatrist’s skills to prescribing medication starts at the top. If training programs let this happen, they are short-changing all of us. If psychiatrists just want to make more money and not learn how to be masters of psychotherapy they are no longer masters of their profession. Master carpenters, master electricians, master cardiologists and masters of anything are an important part of creating a society based on excellence. Excellence is what we should strive for.

Is psychiatry dying?

Not in my office…

Art Smukler is an award-winning psychiatrist and author of Chasing Backwards, a psychological murder mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear. All are available as paperbacks and eBooks.

ISIS (The terrorist Islamic state) finally got our government’s attention. Their blatant, vicious beheading of journalist James Foley was so in our face that no one could ignore for one more second what is happening in northern Iraq and Syria, and in fact all over the Middle East.

Just like President Obama, most of us are reasonable people and feel that everyone should be treated fairly and their beliefs respected. That idea of fairness is flawed when one is dealing with Islamic terrorists. Nothing they say or do can or should be believed. Their goal is to destroy anyone and everyone who doesn’t conform to their ancient cancerous ideas.

It’s no wonder that we suspect and fear the motives of all believers of Islam. Why did it take so long for the president of Indonesia to say publicly that these terrorists bring shame to all sincere, caring Muslim believers and that Islamic leaders should unite in attacking extremism? Why haven’t these leaders done something?

Why aren’t millions of “good” Muslims speaking out against the twisted “evil” Muslims? Why aren’t the millions of american Muslims marching with american flags in anger and horror at what is going on in the Middle East and supporting freedom and women’s rights? Is their silence affirmation and tacit agreement with the terrorists?

Fear? Reprisal? Insecurity?

Maybe. But at some point, a people must stand up for what they believe in. Just like in the sixties when activists marched for the rights of blacks in this country, why aren’t Muslims marching in support of american values and against Islamic terrorist values?

Finally, our president is doing what needs to be done. Terrorists must be stopped. We are at war for our very existence. Another Hitler has emerged and someone has to stop him.

Why should a psychiatrist have any special insight into the mind of a terrorist? I deal with people who are motivated to look into themselves on a daily basis. Who better to have an opinion regarding people who have no interest in examining themselves and are determined to kill people who don’t agree with them…