Unhinged will not be officially released until May 18, but for a preview, read my article, “Mind over Meds,” in this Sunday’s New York Times Magazine. In the article, I focus on one of the topics covered in Unhinged—namely, the abandonment of psychological mindedness by psychiatrists. When I went into psychiatry, I did so because I was fascinated by the mind. But what I encountered during training was a field that was hypnotized by the idea that psychiatry is primarily a medical, rather than a psychological specialty. Rather than understanding people, the goal of psychiatry had become diagnosing disorders, and matching disorders up with medications to treat symptoms. I had assumed I would become a psychotherapist who also prescribed medications when needed. Instead, I was trained to become a psychopharmacologist. When a patient needed therapy, I learned how to figure which therapist to refer the patient to, rather than how to actually do that therapy. I believe this is one of the central crises facing psychiatry today.
If you see a psychiatrist, ask yourself whether he or she really understands you as a person. Does your psychiatrist know what makes you tick? How much have you learned about yourself, about your needs, your goals, and how to attain happiness? Some psychiatrists do, in fact, provide the entire package of medication plus psychotherapy. If you are lucky enough to have found someone like that, you are unusual, because the latest research shows that only 10% of psychiatrists offer therapy to all their patients. Instead, most of us split up the treatment, prescribing medications during 15 to 20 minute visits, and farming the therapy out to a social worker or a psychologist.
It is as though we are splitting our patients into two people. One is a soup of neurotransmitters, and the other is a person. For some patients, this split treatment model works fine, but for many patients it causes fragmentation of care, and that’s not good treatment. As professionals, we can do much better than that.