4.28.2010

Psychology - Either Mindless or Brainless

Interesting article from the New York Times Magazine about the evolution of clinical psychology over the years. Where once it was all on-the-couch type stuff, now a lot of mental health MDs reach straight for the scripts. As Daniel Carlat writes, (Mind Over Meds) the newer generation of headshrinkers educated after the 1980s, came into the profession skeptical of therapy and more focused on neurochemical causes of mental illness.
"Leon Eisenberg, an early pioneer in psychopharmacology at Harvard, once made the notable historical observation that “in the first half of the 20th century, American psychiatry was virtually ‘brainless.’ . . . In the second half of the 20th century, psychiatry became virtually ‘mindless.’ ” The brainless period was a reference to psychiatry’s early infatuation with psychoanalysis; the mindless period, to our current love affair with pills. J.J., I saw, had inadvertently highlighted a glaring deficiency in much of modern psychiatry. Ultimately, his question would change the way I thought about my field, and how I practiced." As a result  "psychiatry has been transformed from a profession in which we talk to people and help them understand their problems into one in which we diagnose disorders and medicate them. This trend was most recently documented by Ramin Mojtabai and Mark Olfson, two psychiatric epidemiologists who found that the percentage of visits to psychiatrists that included psychotherapy dropped to 29 percent in 2004-5 from 44 percent in 1996-97. And the percentage of psychiatrists who provided psychotherapy at every patient visit decreased to 11 percent from 19 percent."
That's what attracted me to psychology twenty years ago -- the complex chemistry of the brian that expressed itself through changes in behavior, cognition and perceptions of reality. I didn't follow that career path because I didn't want to listen to people tell me their problems day in and day out. Yet, over the years there has developed a whole specialty of psychiatry now that JUST focuses on the meds. Carlat wonders if that isn't doing the patients, and the profession, more harm than good. 

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