Monday, March 7, 2011


Leave it to the NY Times Well Blog to come up with salient issues. On March 5 it published "Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy"(

The piece describes how tough practice is for Pennsylvania psychiatrist Dr. Donald Levin. Schooled in the classical "talking cure," he's discovered his craft's devolution is perfectly parallel to that of family practitioners: insurance rewards short visits. Spend decent time with patients, and soon you'll be eating nothing but ramen.

About the time Dr. Levin began his training, I, too, looked into becoming a psychiatrist. My medical school's style of psych training was paleolithic, confined to behavioral therapy, which I found repulsive, and psychoanalysis, which was expensive, interminable, and relatively ineffectual. Peeking into psych residencies, I found it was something entirely different, a Brave New World of psychoactive drugs. Phenothiazines were revolutionizing schizophrenia treatment, and drug after designer drug was sliding down the pipeline to treat other conditions. In other words, it looked like psychiatry would soon become behavioral engineering through pharmacology. Nope, not for me.

Sure enough, that's what happened. My shrink friends' practices gradually turned toward fifteen-minute drug adjustments. New chemicals were touted as treatments for almost every kind of behavior, as though Big Pharma was outright inventing drug-treatable maladies. Indeed, that's today's state of the "art."

A friend who's a psych nurse in Massachusetts told me she took a week-long intensive refresher course in psychiatric medications. It was so replete with exceptions, variations, deviations, and qualifications that when it ended she approached the instructor and said, "Let me get this straight: it's a total crap-shoot, right?" The instructor nodded, "Right."

The psychiatrists and other docs who went into this business for its deliciously deep human contact are justified in feeling this terrible loss. I hear their complaints personally and read reams of them online. What are they to do to treat their pain, a potential source of depression? Of course, they can find some pill to take--and many do. But they can also approach their situation with genuine therapeutic intent, say, by seeing a well-trained non-MD counselor.

The essay contrasts Dr. Levin's experience with that of a former colleague, Dr. Louisa Lance, who practices personal-contact psychiatry. She courageously cut ties with insurers, so she no longer works for them, but solely for her patients. Treating fewer patients in a week than Dr. Levin treats in a day, she says, “Medication is important, but it’s the relationship that gets people better.”

1 comment:

  1. What struck me most about the article was Dr. Levin's venality. He talks the talk about missing his "calling," but he states outright that he wasn't willing to give up his expensive lifestyle. He CHOSE to be the 15 minute drug-fairy and now he whines? Jerk.