Psychiatry – All Meds, No Talk

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.

So opens the New York Times’ article, Talk Doesn’t Pay, So Psychiatry Turns to Drug Therapy by Gardiner Harris.

Using the story of Dr. Donald Levin, the journalist Harris illustrates the dramatic changes that have happened in psychiatry over the past two decades. Levin trained in both psychotherapy and pharmacotherapy. Now he practices exclusively the latter, while lamenting the loss of the former. His wife, herself a social worker, took over the business side of the practice. The in-depth look at how they run an economically successful practice in New York City is fascinating, revealing just how much what Dr. Levin does rests on economic and technological factors well beyond his control and not always to the benefit of his patients.

It’s also revealing of how psychiatry’s role has changed in mental health care delivery. Psychiatrists are becoming more like the primary care physician for the brain. As Dr. Steven Sharfstein, former head of the American Psychiatric Association, puts it,“It’s a practice that’s very reminiscent of primary care. They check up on people; they pull out the prescription pad; they order tests.”

Dr. Levin is more prosaic:

“I had to train myself not to get too interested in their problems and not to get sidetracked trying to be a semi-therapist… I miss the mystery and intrigue of psychotherapy. Now I feel like a good Volkswagen mechanic.”

Link to NYT’s Talk Doesn’t Pay, So Psychiatry Turns to Drug Therapy.

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2 Responses to Psychiatry – All Meds, No Talk

  1. aek says:

    The Levins are running a business. Dr.Levin categorically states that he purposefully ignores patients’ reports of problems and suffering. His wife, the office manager, is not by any stretch of the imagination, acting in a bona fide social work role. She has a single interest: the financial bottom line.

    Nowhere in the story, does the patient’s best interest and medical ethics get mentioned.

    Moreover, psychotropics are being shown to cause so many physiological and cognitive derangements that Dr. Levin should be performing physical and diagnostic exams at every visit, and it is clear that he is not doing so.

    This is snake oil at its worst, and patients’ welfare is directly jeopardized.

  2. What seems strange to me is that the story of psychiatrists going to meds over talk has already been written. In April 2010, an article titled “Mind Over Meds” was trying to push things in the other direction. I haven’t followed whether Carlat’s book Unhinged: The Trouble with Psychiatry has had any impact, but this article does not seem to mention any pushback.