If a recent story in The New York Times is to be believed, psychiatrists are ditching talk therapy in favor of quick-to-the-draw prescription solutions because insurance companies won’t pay them enough for the broader treatment.
As someone who benefited greatly from both therapy and medication, I find this disturbing.
Like many of the nation’s 48,000psychiatrists, 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.”
This is tragic on so many levels.
I’ve said it before: Medication (Prozac) has been a critical part of my OCD management. It put my defective brain chemistry into balance and greatly reduced the moments where my brain would pulsate out of control with worry and obsessions until it incapacitated me.
But had I gone on the drug without doing the brutally hard therapy first, I would not be doing anywhere near as well as I am today. I can promise you that.
Mental health is like physical health. There is no magic bullet — or magic pill — fix. You need a combination of diet, rest and exercise to maintain health as well as any medicine that you may need.
Talk therapy helps you build your coping tools from scratch. They become your lifeline to sanity, especially if the drugs stop working, which can happen in a variety of circumstances.
This is just one more example of the health insurance industry putting the bottom line before wellness. I don’t want to beat on the insurance providers just for the hell of it. The industry does face the genuine problem where treatments are becoming more expensive, especially in a population where many refuse to take care of themselves.
Now that I’ve gotten that out of the way…
There are things one can do to cut costs. But when you cut into the muscle of the treatment — in this case talk therapy — the treatment will bleed to the point of near-death.
Now I know what they’re thinking: People can go to a therapist for talking and the other guy for medication, but now we have another problem. Not everyone can afford both.
In my case, I go to a therapist to talk things out, and a nurse on his staff is authorized and in charge of writing my prescription.
Psychiatry and therapy are not exactly the same beast.
But a good psychiatrist includes the talking part and uses it to maximum effect.
Force them to stop doing that and many people will fall through the cracks.