Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy

During a time when I worked as a temp, I worked for a group of 6 psychiatrists. This was back in the early 90's. Even back then they were limiting their appointments to 15 minute drug based quickies. Most of these people were trying to cope with their entire lives being destroyed. They were sent to therapists for talk sessions. The problem with this was that there were not enough therapists to go around and it is even worse now.

For PTSD, the best results come from talk therapy. Either one on one or in group, depending on the veteran. What we're seeing now is that there are less therapists to listen and more psychiatrists focusing on writing prescriptions. In other words, a lot more drugging and a lot less healing.

Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy
Written by Gardiner Harris
Monday, 07 March 2011 11:36

March 5, 2011 (New York Times) - Alone with his psychiatrist, the patient confided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and second marriage falling apart, the man said he needed help.

But the psychiatrist, Dr. Donald Levin, stopped him and said: "Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate."

Like many of the nation’s 48,000 psychiatrists, Dr. Levin, in large part because of changes in how much insurance will pay, no longer provides talk therapy, the form of psychiatry popularized by Sigmund Freud that dominated the profession for decades. Instead, he prescribes medication, usually after a brief consultation with each patient. So Dr. Levin sent the man away with a referral to a less costly therapist and a personal crisis unexplored and unresolved.

Medicine is rapidly changing in the United States from a cottage industry to one dominated by large hospital groups and corporations, but the new efficiencies can be accompanied by a telling loss of intimacy between doctors and patients. And no specialty has suffered this loss more profoundly than psychiatry.

Trained as a traditional psychiatrist at Michael Reese Hospital, a sprawling Chicago medical center that has since closed, Dr. Levin, 68, first established a private practice in 1972, when talk therapy was in its heyday.

Then, like many psychiatrists, he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. Then, he knew his patients’ inner lives better than he knew his wife’s; now, he often cannot remember their names. Then, his goal was to help his patients become happy and fulfilled; now, it is just to keep them functional.

Dr. Levin has found the transition difficult. He now resists helping patients to manage their lives better. "I had to train myself not to get too interested in their problems," he said, "and not to get sidetracked trying to be a semi-therapist."
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Talk Doesn’t Pay