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16 2011

"Talk doesn’t pay, so psychiatry turns instead to drug therapy"

Syndicated from: Editor's corner

That was the front-page headline in the New York Times on March 5. The story recounts the experiences of Dr. Donald Levin, a 68-year-old psychiatrist who used to do a lot of talk therapy and now does nothing but prescribe psychiatric drugs to his clients. When they start to talk about their real-life struggles, he sends them away. "I had to train myself not to get too interested in their problems, and not to get sidetracked trying to be a semi-therapist," he says.The article focuses not so much on the shifting nature of psychiatric care and the long-standing debate about the merits of psychotherapy versus psychopharmacology, but on the economics of psychiatric practice; none of this is front-page news. What perhaps gripped readers most, from what the Comments section reveals, is the fear that Dr. Levin has injured the profession's image. Most readers were thinking less about the state of psychiatry and more about Dr. Levin, and hoped that he isn't the norm. Whether it was a good idea for Dr. Levin to acknowledge his practice publicly and whether he represents psychiatrists in general is one question. But I return to the issue of the changing nature of psychiatric care, which seems to have pushed aside talk therapy to make way for more pharmacotherapy. It's a fact that psychiatrists are talking less and prescribing more. The NYT article cites a 2005 government study which found that 11 per cent of psychiatrists in the United States no longer provide talk therapy, focusing instead on prescribing medication. The irony is that talk therapy is emerging as a precise science that relies less on the therapist's experience and judgment and more on evidence-based interventions. Recent research, for example, has found that talk therapy and mindfulness may be as good as or better than drugs in treating depression.  The focus on medication also seems to be at odds with new curricula in medical schools. Many offer electives and even mandatory courses in narrative medicine, the humanities, ethics and doctor-patient communication. Are students prepared for the reality of clinical practice, or will they become a new breed of caring practitioners who can prescribe medication without losing sight of what's most important in their work -- their clients and patients?    

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