Wednesday, July 14, 2010


"Unhinged: The Trouble With Psychiatry." The book doesn't just concern the influence of drug companies in the profession. Carlat believes in prescribing medication, but he says too many psychiatrists have all but abandoned talk therapy — leaving in-depth interaction with patients to others — while they pursue medical fixes for mood problems and mental disorders.

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This is the exact same type of problem my old man had with the medical industry. But as a doctor he chose to spend more quality time with fewer patients, at the risk (and immediate fact) of not making nearly as much money. Part of this is choice –an ethical one, which is foreshadowed by the “income differential” (which Dan Carlat calls himself out on, is aware of, by being a psychiatrist and not a therapist), and the other is actual limitations imposed by the business in contracts with pharmaceutical companies, medical tech companies, hospital CEO’s, etc. The latter of which can be just as disconcerting to the practitioner who requires more freedom to practice in a thorough, methodical manner. Very frustrating, and a real concern for practitioners and patients alike. He did everything he could to talk his sons out of becoming a doctor. (lucky for him, I isn’t smart enough anyway!)

I also had a professor teach us in depth about these pitfalls of the American Psychiatric industry as well. He called it a triple-bind system, which establishes that the therapist be dependent on the APA and drug companies for regulations, standards, and product; the patient be dependent on the therapist for treatment and controlled substances; the companies dependent on the patients continually needing treatment for new diagnoses (i.e., stimulating and maintaining demand). He amplified this lament with the fact that DSM diagnoses never leave one’s record and that some organizations and individuals, (however seemingly highly illegal and obviously unethical) in light of mandates confidentiality, can access a main national database of all U.S. patient records with the right credentials/means, for multiple reasons. (e.g., employment concerns, political sleuthing, Homeland Security) Sounds like a conspiracy, but it aint.

This is a guy who hid his under-insured patients records under his bed at home and counseled them for free, so there was no liability or oversight.

Quick psychobabble: Is this the death knell of psychoanalysis? We need another revolution in psychology, but it will probably not come from or any new form of psychotherapy, but from advances in neurology (neuro-engineering). And I do fear the ramifications of physical transmitter-tinkering. Can we re-program/overwrite pathology?? You need to understand the cause before you can treat the effect.

Food for thought.

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