A prominent psychiatrist, Daniel Carlat, MD, made an eloquent argument in Sunday’s New York Times Magazine for rethinking the medication-only approach that many psychiatrists follow in treating mental illness. Carlat, himself a psychopharmacologist, recounts his own reawakening to the importance of looking at the environmental and psychological factors that should influence treatment for common ailments such as depression and anxiety:
“I realized, uncomfortably, that somehow, over the course of the decade following my residency, my way of thinking about patients had veered away from psychological curiosity. Instead, I had come to focus on symptoms, as if they were objective medical findings, much the way internists view blood-pressure readings or potassium levels. Psychiatry, for me and many of my colleagues, had become a process of corralling patients’ symptoms into labels and finding a drug to match.”
I’m one of those patients in whom doctors have struggled to pin down symptoms and match up a pill or capsule to quell my mental and emotional tempests. I despise people who ignorantly argue that meds don’t work at all and that they’re the greatest pharmaceutical sham in modern history. But I also think that splitting the biological from the psychological and social has resulted at times in doctors (and probably patients) taking the easy way out. Without meds, I wouldn’t stand a chance of getting better. My depressions are so complete and catastrophic that no amount of talking ever really pulls me out of them. On the other hand, really good therapy has meant that I no longer engage in thoughts and behaviors that destabilize me in the first place.
Ultimately, Carlat argues that the artificial split in treating mental illness--where your psychopharmacologist tames the fury of biochemistry gone wrong in your head, while your psychologist or social worker heals your heart and soul--is a dichotomy that doesn’t help the patient and ultimately doesn’t even save money for the insurance companies who reinforce the divide.
It’s a beautifully argued, intelligent and nuanced article that should be read by every person struggling with a mental illness, and I’ll certainly buy Carlat’s book (or check it out of the library) when it becomes available next month.