In the late eighties, managed care became an intrinsic part of our healthcare system.
The goal of saving patients money and still providing excellent care was a blatant lie. Psychiatrists were penalized for doing psychotherapy by receiving lower reimbursement fees. Only if they focused their efforts on psychopharmacological management of the patient’s treatment could they make a decent living. It even influenced the way psychiatrists were trained. Many programs reduced the emphasis on learning intensive psychotherapy, focusing mainly on diagnosis and the treatment of disorders like schizophrenia, major depressions and bipolar disorders. Learning how to tease out the clues that would allow a patient to change the way he was behaving and cure his depression and miserable life were no longer seen as an essential part of the training programs.
Because drugs like Prozac, Paxil, Zoloft, Celexa, Lexapro, Wellbutrin, Effexor, Cymbalta, Pristiq etc. were such effective blockbuster money makers, drug reps would not only detail psychiatrists, but also family practice doctors, internists, gynecologists and any doctor who might have the opportunity to treat issues like depression and anxiety. If a patient came in to see his doctor for depression, he might very well be given a prescription for Prozac and told to make an appointment for a follow-up in a month. Often, the thought of referring someone to a psychiatrist would only occur after a suicide attempt or overt psychotic break.
BUT, no-matter how often the power of psychopharmacology was touted, it became clear that managed care, big pharm, and the change in training programs couldn’t alter the fact that in many, many cases, MEDS ALONE DIDN’T HELP CURE DEPRESSION.
Those of us who understand and use psychotherapy (and meds) to treat depression, know that often the real drug (the magic elixir) that cures depression, is expressing unconscious underlying anger. These angry feelings often date back to early childhood, when the fear of confronting an angry parent was foolish. How can a child conquer a giant ten times his size who has ALL the power?
So, if anger is unconscious, how can you express what feels like it doesn’t exist?
If you are depressed and the medication you’ve been given isn’t really helping, don’t despair. Not all things that are new and wonderful are correct. Sometimes, it’s the simple, logical things that are the real answer. Find a skilled therapist who really knows what he’s doing. The magic of uncovering unconscious demons really works and can make you feel a lot better.
Do you agree? Disagree? Any personal experiences?
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.
Inside The Mind of a Psychiatrist 