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A PSYCHIATRIST LOOKS CRITICALLY AT HIS OWN PROFESSION
By Steven H Propp
Author Daniel Carlat wrote in the first chapter of this 2010 book, "I will take you on a guided tour of the landscape of modern psychiatry. I will show you what we actually know about the mind---versus what we only pretend to know. I will argue that we psychiatrists spend our days splitting our patients into two: one is a repository of neurotransmitters, and the other is a person with relationships, a job, and aspirations. We treat the neurotransmitters, and we refer the person to someone else. The surprise is that our treatments are remarkably helpful to patients, even though we hobble ourselves in this way. Imagine how effective we could be if we embraced all the tools at our disposal." (Pg. 16)
He admits, "Most people are under the misconception that an appointment with a psychiatrist will involve counseling, probing questions, and digging into the psychological meanings of one's distress. But the psychiatrist as psychotherapist is an endangered species. In fact, according to ther latest data ... only one out of every ten psychiatrists offers therapy to all their patients. Doing psychotherapy doesn't pay well enough. I can see three or four patients per hour if I focus on medications... but only one patient in that time period if I do therapy... psychiatrists have generally followed the money." (Pg. 4-5) He adds, "There was a time when I thought this shift in the profession was a natural evolution. Why put patients through months and years of weekly therapy if simply taking pills worked as well if not better? As it turns out, we were wrong in two ways. We both exaggerated the effectiveness of the new drugs and gave psychotherapy a premature burial." (Pg. 12)
He states, "The tradition of psychological curiosity has been dying a gradual death... In the past... treatment entailed constructing elaborate explanations for how symptoms developed through early childhood experiences... The climax of treatment would be an 'interpretation'... Many such explanations were, no doubt, true, but unfortunately the truth did not necessarily set patients free. Symptoms stubbornly remained. Gradually, the profession became disillusioned with psychoanalysis, and turned to other methods, such as psychopharmacology." (Pg. 45-46)
He points out that "The idea that depression is a 'chemical imbalance' derives from how the drugs work. We have come to the theory through a process of deduction, reasoning backward from the effects antidepressants have on neurotransmitters. Antidepressants... treat depression. Ergo, depression must be caused by a DEFICIENCY of such neurotransmitters... But the problem is that there is no DIRECT evidence that a ... deficiency is involved." (Pg. 76-77) He adds, "The fact is that psychopharmacology is primarily trial and error, a kind of muddling through different candidate medications until we hit on one that works." (Pg. 83)
After noting the large number of drug study results that are suppressed and/or never published, he states, "If I relied on the published medical literature for information... it would appear that 94 percent of all antidepressant trials are positive. But if I had access to all the suppressed data, I would see that the truth is that only about half... of trials are positive... If there is only a fifty-fifty chance that an antidepressant drug study shows the drug to be effective, what does this mean for the patients taking these drugs? Is everybody taking a placebo, and only fooling themselves into believing that these drugs work?" (Pg. 117)
This is a fascinating, insightful, and controversial book that will be of great interest to anyone studying the pharmaceutical industry, modern psychiatry or psychology, or the medical profession in general---whether one always agrees with Dr. Carlat or not.
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