By Gardiner Harris, New York Times, March 5, 2011
Doylestown, PA. — Alone with his psychiatrist, the patient confided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and second marriage falling apart, the man said he needed help.
But the psychiatrist, Dr. Donald Levin, stopped him and said: “Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.”
Like many of the nation’s 48,000 psychiatrists, Dr. Levin, in large part because of changes in how much insurance will pay, no longer provides talk therapy, the form of psychiatry popularized by Sigmund Freud that dominated the profession for decades. Instead, he prescribes medication, usually after a brief consultation with each patient. So Dr. Levin sent the man away with a referral to a less costly therapist and a personal crisis unexplored and unresolved.
Medicine is rapidly changing in the United States from a cottage industry to one dominated by large hospital groups and corporations, but the new efficiencies can be accompanied by a telling loss of intimacy between doctors and patients. And no specialty has suffered this loss more profoundly than psychiatry.
Trained as a traditional psychiatrist at Michael Reese Hospital, a sprawling Chicago medical center that has since closed, Dr. Levin, 68, first established a private practice in 1972, when talk therapy was in its heyday.
Then, 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.
The insurance companies are winning the battle of control over the practice of medicine in the United States.
And the insurance companies constitute a economic and political cabal with the pharmaceutical industry in order to elevate the drug therapy to the "only treatment that the insurance companies will pay for," essentially creating a medically supported, drug-dependent society. And the rest of the world wonders, usually out loud, why the United States is SO drug-dependent, including both prescription and non-prescription drugs.
Dear reader there is no reason for wonder. The case is clear that the individual context of the patient's life is virtually irrelevant to the practicising psychiatrists who is going to be paid for medication/drug prescription.
And we thought that Huxley's world of "soma" was far-fetched in his novel, Brave New World, a dystopia that foresaw this kind of inevitable (to him) development.
We have finally come to this, that intelligent, even confrontative and professional conversation is no longer relevant to the insurance companies whose dictates govern the practice of medicine.
Imagine the implications of this development on the teaching of medicine and especially psychiatry, in the thousands of medical schools across the globe.
Where in the world will the individual character, biography and cultural context of human lives still matter, if at all, and if anywhere?