Tuesday, October 23, 2012

How Has Psychiatry Changed: On National Public Radio


Our blogger friend, Steve who writes on Thought Broadcast, was on Talk of the Nation yesterday to discuss trends in psychiatric treatment.  If you didn't get a chance to listen, I'm taking the liberty of embedding the interview here.  Steve did a great job!

Okay, Steve, time to get off Facebook and write another blog post, it's been a while!


Ian said...

So, good care is something that takes a lot of time and is prohibitively expensive? Even though there was no evidence provided that what Friedman considers good care is robustly more helpful to people than other care.

ClinkShrink said...

I have to say I found myself getting mildly annoyed around minute 4 when Steve said psychotherapy is "big and important" in NYC training programs but not in the Midwest.

If you're living in a region where there is one psychiatrist for 80,000 people and your patient is about to lose his fourth generation family farm to foreclosure, interest and demand for psychotherapy is going to be considerably less than in a city with one of the highest per-capita supplies of psychiatrists and where a six figure income is middle class. For some people, psychotherapy is a luxury indulgence and not an essential treatment.

Dinah said...

ClinkShrink: interesting take on it that because there aren't enough psychiatrists in certain areas, then psychotherapy is a "luxury"...
New York City's suicide rate is just over half the national average. Maybe having all those shrinks saves lives.
(I'm not sure that psychotherapy is relevant to the equation)

Feb. 23, 2012 – The New York City Health Department announced today that the city’s overall suicide death rate is just over half the national rate (6 deaths per 100,000 in NYC vs. 11 deaths per 100,000 people in the U.S.), according to a newly released “NYC Vital Signs” report on suicide and self-inflicted injuries.

mara said...

I miss Steve! He needs to start blogging on Thought Broadcast again. It has been far too long since the last post.

I do like that he acknowledges that pdocs don't always know why someone got better. Was it the meds? Placebo? Psychotherapy? Changes in the personal life of the patient? In a med management setting, that would be very difficult to tell.

And around half the country gets a mental illness at some point? I thought that number was awfully high. I have trouble believing half the country is either mentally unstable or will develop clinically significant mental instability at some point...

mara said...

Also I would like to add that I don't think psychotherapy is a luxury in some cases. Some people do not respond to medication, or cannot take them, and psychotherapy is the only helpful treatment they can get.

Abbey Normal said...

I think the key is having a competent psychiatrist. There seems to be an assumption that patients are short changed if they get med checks or they want the "quick fix." I don't feel that way. I get my psychotherapy elsewhere and that works for me.

In the past I had a psychiatrist who also provided psychotherapy + meds and I deteriorated under his care. By the time i left his practice i was way over medicated, no longer employed, and i had been hospitalized three times. i left a complete mess. Sure, he spent time talking but that doesn't mean it was quality time. He quoted movie lines, he told me my eyes were the window to my soul, he told me about his mercedes, I heard about his trip to the Netherlands, and so on.

i also saw a psychiatrst who provided med checks only and she too was a bust. It was like talking to a block of wood. The woman had no facial expressions whatsoever. Were I the psychiatrist i would have noted her flat affect. i saw her once and never went back.

it took a while to find a psychiatrist who was a good fit. My psychiatrist now, provides 15 min med checks (with the exception of the initial appointment which was really long). He is kind, professional, he gets to the point which i appreciate, i take a lot less meds than with my previous psychotherapy + med psychiatrist,and most importantly i've improved under his care. in the time i've been seeing him i have not been hospitalized and i'm employed.

Early on when i was doing really badly he tended to go over the 15 min, now that i'm doing well we talk a lot less than 15 min and that works well for me. He's available to his patients, and he tells me to call if i need anything. He is well regarded in the community by
by both psychiatrists and patients.

So, i think what matter most is finding a psychiatrist who is both good at what they do and who is a good fit for the patient. That may mean meds only, psychotherapy only, meds + psychotherapy, or none of the above. Different things work for different people.