A prescient psychiatrist, circa 1998

[thatcrazycajun]

Courtesy of StumbleUpon.com, a shrink who said a lot of what I've been saying about the medical profession in general today, with much more authority, years ago:
Famous psychiatrist L.R. Mosher resigns from the American Psychiatric Association in disgust

Comments

[pocketnaomi.livejournal.com]

Speaking as somebody whose life is going well, whose support network is excellent, whose coping strategies and cognitive skills in handling her illness are pretty goddamn good if I do say so myself, and who is nonfunctional right now because her medication isn't working, I have to say I don't really like either side of this argument. Some psychiatric problems really *are* just plain imbalances of neurochemistry, and there is not a damn thing you can do about them besides correct the biological imbalance. It may be bad policy to lean that heavily on the drug companies, but it is just plain deadly malpractice to refrain from medicating a patient whose neurotransmitters are severely out of whack. If it hadn't been for the psychopharmacologists, I'd be dead by now.

[thatcrazycajun.livejournal.com]

Stipulated, my dear friend, stipulated. I too am dependent on the psychopharmacologists...but dammit, I don't like having to be. Yes, absolutely, doctors should be able to prescribe drugs when, in their best medical judgment, it is appropriate. What I object to is the swing all the way to one end of the spectrum, i.e., the medical profession letting the drug companies' patent-expiration schedules dictate which drugs get pushed on them by pharmco reps and by patients bombarded with TV and magazine ads. I didn't say I agreed with *all* of what Dr. Mosher has to say -- just some of it.

[pocketnaomi.livejournal.com]

I know plenty of psychiatrists who don't do this. They use the drug companies' reps as one source among many for information on what tools are available for their patients. I suspect that in most cases, the ones who lean too heavily on the advertising are simply not bright enough to sort out the available options for themselves... which unfortunately also would make them really bad at doing other forms of therapy, too. There's not really a simple solution to having a not very smart psychiatrist, other than go get a different one.

[osewalrus.livejournal.com]

I suspect it has much to do with training, personality type, and what sort of environment you are in. HMOs are very different from sole practitioners, say.

[catalana.livejournal.com]

*wryly* Speaking as someone whose mother worked for the APA national headquarters...yeah, I agree. You'd be really depressed to know how much politics is involved in it.

[osewalrus.livejournal.com]

The transition inpsychiatry happened in the late '80s and early '90s. It shfted from talk-focused therapy supported by medication to medication-based therapy suplemented by traditional talk therapy.

There are many reasons for this, some good and some bad. There's economics (insurerers like medication rather than endless talk therapy). There's the shifts in the debate on "do we have consciousness or is it all just chemicals interacting". And there is what works and what doesn't. In the 1980s, the demonstration of the effectiveness of the first class of SSRI anti-depresants really gave talk therapy a kick in the patootie. A pill could achieve what years of talk therapy couldn't. Add in that Frued, who had been a major pillar of talk therapy, was increasingly discredited, and it is unsurprising that the economic factors pushed things in one direction.

We are starting to see some swing back now. There is renewed interest in talk therapy, as medication hits its limits and there are still things the chemical models of the brain can't account for.