For families of loved ones with severe mental illness, good psychiatry is critical to recovery success. But these days, a good psychiatrist is hard to find. The industry of psychiatry has dramatically changed. Gone of the days of relationship-based talk therapy. Advances in psychiatric medications, the ascendant market power of health insurance companies, and in no small measure the short-sighted insularity of the profession itself have all contributed to a devolution of psychiatrists from holistic healers to drug dispensers. This trend is expected to accelerate with the coming changes in Medicaid programs at the state level and the implementation of the Affordable Care Act of 2010.
Last March The New York Times ran a front-page article on this sad trend. Entitled “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy”, the article recounts the experience of Dr. Donald Levin of Doylestown, PA. “I miss the mystery and intrigue of psychotherapy,” he said. “Now I feel like a good Volkswagen mechanic.” Referring to his new role as medications prescriber, Levin laments the change. “I’m good at it,” Dr. Levin went on, “but there’s not a lot to master in medications. It’s like ‘2001: A Space Odyssey,’ where you had Hal the supercomputer juxtaposed with the ape with the bone. I feel like I’m the ape with the bone now.”
More from the article:
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 psychiatrypopularized 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.
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