A Psychiatrist’s Descent Into Pill Pushing

A story in yesterday’s New York Times illustrates a growing problem in today’s mental health treatment world. This is a world that is actually becoming more callously bureaucratic, and less caring, in any real sense, as time goes on. Psychiatrists are ceasing to provide talk therapy because insurance companies are no longer willing to pay for it. This cessation of meaningful interactions between doctor and patient has turned our psychiatrists into little more than drug pushers for the pharmaceutical industry. The headline of the article, which concerns the practice of one Donald Levine, says it all: Talk Doesn’t Pay, So Psychiatry Turns to Drug Therapy. Patient care has deteriorated as a result, and it continues to suffer.

Then [in and around 1972], like many psychiatrists, he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. Then, he knew his patients’ inner lives better than he knew his wife’s; now, he often cannot remember their names. Then, his goal was to help his patients become happy and fulfilled; now, it is just to keep them functional.

As a result of these changes the madness factories are working at max capacity churning out doped up and zombified lifelong mental patients. Excuse me, mental health consumers.

Recent studies suggest that talk therapy may be as good as or better than drugs in the treatment of depression, but fewer than half of depressed patients now get such therapy compared with the vast majority 20 years ago. Insurance company reimbursement rates and policies that discourage talk therapy are part of the reason. A psychiatrist can earn $150 for three 15-minute medication visits compared with $90 for a 45-minute talk therapy session.

The job of establishing a rapport with the patient has switched over to other, and usually less well trained, psychology and social work professionals.

When he started in psychiatry, Dr. Levin kept his own schedule in a spiral notebook and paid college students to spend four hours a month sending out bills. But in 1985, he started a series of jobs in hospitals and did not return to full-time private practice until 2000, when he and more than a dozen other psychiatrists with whom he had worked were shocked to learn that insurers would no longer pay what they had planned to charge for talk therapy.

Dr. Levin’s youngest son, Matthew, is following in his father’s footsteps, and training to become a psychiatrist, too. This inheritance is especially troubling as he is being educated in child and adolescent psychiatry. Some of the more major children’s mental health conditions that were rare to nonexistent just a few years back have suddenly exploded into abundance. This heightened mental health crisis has no doubt been exasperated by the pharmaceutical companies’ rapacious manuevering to expand their markets into such new and fertile demographic territory.

In a telephone interview from the University of California, Irvine, where he is completing the last of his training to become a child and adolescent psychiatrist, Dr. Matthew Levin said, “I’m concerned that I may be put in a position where I’d be forced to sacrifice patient care to make a living, and I’m hoping to avoid that.”

The moral of this tale is that we desperately need a paradigm shift in the providing of mental health care. If insurance could be used to fund safe and effective alternatives to conventional psychiatry (i.e. pill pushing), then mental health recovery rates would go up appreciably as a result. Dr. Donald Levine refers to himself as something akin to a Volkswagen mechanic in this article. “Medication maintenance”, the kind of maintenance most of these people mechanics provide today, keeps people incapacitated and disabled for life, and it does not effectively recover them to a productive role in society. People need to realize this fact, and they need to find a way to compel insurance companies to pursue other more worthwhile options and ends.

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4 Responses

  1. Another well-written, and thought-provoking post.
    I agree with you, 100 percent!

    Thank you for getting the word out!

    My best,

    Duane Sherry, M.S

    • Thanks, Duane. Always good to hear from you. I wouldn’t mind hearing from people who disagree with me as well. I’d love to see what kind of discussion might ensue.

  2. The sad thing in all of this is that US doctors have come to believe that they are uber people who should be making obscene amounts of money, which is the bribe the drug and insurance companies have been paying them in the past fifty years or so.
    The blame for the deteriorating level of care that patients can expect to receive from doctors lies squarely on the doctors’ shoulders, regardless of how much they try to blame the insurance companies. It is the doctors’ greed and lack of moral conscience that drives the lack of caring. If the doctors objected to the miserable practices imposed on them and on us by the drug and “health insurance” companies, the latter would not have the power and influence that they do. It is the doctors who forgot their sacred mission, and the first to blame for the state of health care in the US.

    • Psychiatrists economically and socially live in another world, usually, from those they treat, and this makes them feel entitled. The blame for the deteriorating level of care does lie squarely on the shoulders of the doctors. If they didn’t prescribe psychiatric drugs to the extent that they do today they would actually be saving lives.

      I wouldn’t say that insurance companies don’t play a role in this situation. These companies pay for the drugs, and they don’t pay for the counseling. Doctors tend to choose the option that will maintain their lifestyle. They are human, they make human decisions, and they make human mistakes.

      I think there is such a thing as expecting too much of a physician, on the other hand, nothing excuses the callous disregard for the physical health of their patients among psychiatrists that we see so often today. Doctors should be more concerned about the health of their clients than the profits of drugs companies, from which they receive kickbacks and perks, and that just isn’t the case today. If it were, they wouldn’t be sacrifising physical health for mental health.

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