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On the Brain: When psychiatrists stop talking
March 10th, 2011
09:05 AM ET

On the Brain: When psychiatrists stop talking

When a psychiatrist compares his office to a bus station, you know something's up. The New York Times has an eye-opening piece about how psychiatrists today mainly prescribe medications and don't have time to talk to patients anymore. Dr. Donald Levin, the centerpiece of the story, keeps telling patients that if they need to delve into their problems, they should see a therapist. Unfortunately, with rigid health insurance structures and limited access to care, that's not always possible.

And given that research has shown that mental health care is best given as a combination of talk therapy and medication, that's a big problem, notes Carol Bernstein, president of the American Psychiatric Association, in a letter to the New York Times.

At the same that psychiatry moves away from an all-encompassing approach to treatment, psychiatric problems are on the rise in the United States.

A recent survey of 11 countries found that the United States has the highest rate of bipolar disorder, at 4.4%, Health.com reported via CNN.com. Eating disorders are more prevalent among teens than previously thought, Bloomberg BusinessWeek says, reporting on a study from Monday's Archives of General Psychiatry. This research also found that teens with eating disorders have a higher likelihood of suicidal thoughts and other mental health problems, the Los Angeles Times reports. Clearly, there is a real, critical need for good mental health care.

But people with these disorders who have deep-seated problems that they want to discuss may have a hard time scheduling that conversation with the same person who prescribes the medication they need. And the psychiatrists aren't saying that's a good thing, either. Levin laments that he doesn't have time to get to know his patients well at all; he works 11-hour days treats 1,200 people.

"I miss the mystery and intrigue of psychotherapy," Levin told the New York Times. "Now I feel like a good Volkswagen mechanic."

If you're in a crisis and want to talk to someone immediately, call the National Suicide Prevention Lifeline at 1-800-273-TALK.


soundoff (51 Responses)
  1. CalJax

    The story really should be how soon patients might not be able to see quality psychiatrists because none of them will want to take government plans.....why because the government will go after them for fraud and treating patients that were "medically unnecessary". AND how there are people out there who fake mental illness to fraud medicare and the doctor who treats them will then be accused of medicare fraud. How the heck is a doctor supposed to know someone is faking bi-polar, especially when the faker knows all the right things to say and has a history of alcoholism among other things? Is the doctor supposed to ask "are you faking today?" And if the patient was signed off by nurse practioners and other doctors....why would the psychiatrist question that? This is happening in this country. Innocent doctors getting railroaded for trying ot treat patients...now that is scary!

    March 10, 2011 at 09:56 | Report abuse | Reply
    • RoadRunner, Albuquerque, NM

      Your histrionic personality isn't contributing very much to understanding the point of this article. M.D. Psycniatrists primarily prescribe medications, and refer to co-professionals to augment with talk therapy, e.g., Social Workers, R.N.s, and/or Psychologists.

      March 10, 2011 at 12:57 | Report abuse |
    • MedExec

      Hey Roadrunner,

      Don't use a legitamate psychiatric condition (e.g., histrionic personality disorder) as an accusation against a blog post you dislike, as you just did with CalJax. That's completely irresponsible. Comments like that only hurt people, and also further hinder our efforts to reduce stigma about mental illness.

      March 10, 2011 at 13:54 | Report abuse |
    • CalgarySandy

      So MedX, it is your view that everyone must agree with a post that is highly negative and encourages the stigma against mental health care.. So, you further the stigma against others by supporting a nasty individual. One of the great things about Democracy is the right to disagree as well as agree. There is nothing wrong with calling someone on an obnoxious post by someone who clearly has a chip on their shoulder and is out to spit on those who are mentally ill and their grieving loved ones. Of course there are cheaters. Every disease has its fakers but we do not stop treatment because of a handful out of millions.

      One in 5 North Americans suffers from a mental illness. That number will surely rise as economic and social chaos increase. Even more people than that love, live with, and have friends or family who suffer badly trying to deal humanely with disorders that are so destructive. That suffering is exacerbated by being put through the stress of people saying they are malingers or fakers. These are neurological disorders are caused by a genetic predisposition aggravated by abuse at anytime in your life and especially childhood. It is not the fault or chose of the ill person to be this way. It is difficult to get help because of the lack of doctors /therapists/nurses in the field and by insurance companies refusing help or limiting it. You both lack empathy and that is a clear sign of psychopathology; which is a psychosis and in the same family as other disorders.

      March 16, 2011 at 16:09 | Report abuse |
  2. ObamaCareBAD

    lets face it, the more government tries to take over healthcare, and the less insurance reimburses, the docs are forced to see patients for shorter times and less money. Don't blame the docs, they have to pay loans and put food on the table, blame the system who tells them they will have half as much time to see twice as many patients and only pays 10%. Healthcare was good when docs got paid WELL for seeing patients... there was no incentive to have 15 minute visits; i remember when my old doc would see me for 30 min visits and i never felt rushed and was never healthier and happier. Reform starts with encouraging new docs to enter the field, and for existing docs to not turn offices into factories.

    March 10, 2011 at 10:18 | Report abuse | Reply
    • followup

      What you call "Obamacare" – which is basically a collection of heath care reforms originally introduced by Republicans but subsequently slandered because Obama was onboard with it, actually requires the insurance industry to provide MORE coverage for mental health and to consider mental health as not less important that other medical health issues. Naturally the insurance companies started an obviously successful campaign to convince the public that health care reform is not good for them. The insurance companies sure fooled us into spitting in the wind on this one, didn’t they?

      March 10, 2011 at 10:31 | Report abuse |
    • Leo

      Try getting new doctors to enter the field with this state of affairs. I wouldn't want to start my career a half MILLION dollars in debt. That's what med school will do to you now.

      I wouldn't want to spend my career fighting with insurance companies, either. Private insurance, which is all about profit, skims SO much money out of the medical system. That's a huge part of why doctors are getting paid so little for each patient.

      Also... health care was "good" when docs got paid well... IF you were wealthy enough to afford it. Granted, at this point, with private insurance leeching so much money from the system, even fewer people can afford it. I have good health insurance, and I work at a hospital, and I can barely afford the bills.

      You see, the problem isn't "obamacare," as you call it. The problem is the big-business, insurance-run, profit-driven system of big capitalism. The attempts at government regulation are TRYING to get the insurance companies to reimburse more to the doctors, and to pay for more necessary procedures, instead of skimming more profit. In Canada, they pay half as much per capita, and get better overall results. Don't talk to me about wait times. It still takes me four to six months just to get appointments to see the specialists I need. I pay my own way, and I see only civilian doctors. (Before you accuse me of being a fat, lazy, liberal layabout... I'm thin, I exercise regularly, I eat right, I work full time, and I'm a veteran.)

      Really, hoss, you've been drinking the Glenn Beck Kool-Aid for too long. You sound like you actually believe this stuff. My old commander told me to always double-check the data before formulating a battle plan. That was a smart man, and that advice saved quite a few lives down the road. So I checked the info about the universal health care, the costs, the quality of care, the wait times, and more. The truth of the matter is that when you actually look at the facts, and not the propaganda, the anti-universal-health-care arguments DON'T ADD UP. UHC makes sense.

      Oh, and before you yell about the incomes of doctors in UHC countries... look up the numbers. Docs in Canada get salaries almost identical to docs in the USA. There are a couple of exceptions... anesthesiologists make a more normal income in Canada, rather than the $400K to $500K they get in the USA (three times as much as a family doctor). But yeah, Canadian doctors get paid well, and they don't have nearly as much debt at the starts of their careers. They also don't have to pay the insane malpractice insurance premiums we have in the USA that are bankrupting good family docs.

      I'm American, but a lot of my family is Canadian. I've experienced the Canadian health care system. The horror stories you hear? They're propaganda. Seriously. Go fact check for yourself.

      Think about it.

      March 10, 2011 at 10:38 | Report abuse |
    • RoadRunner, Albuquerque, NM

      You are trying to politicize a treatment issue that is already being addressed within the healthcare system. Look at the model of Behavioral Health Care system as practices in the Veteran's Administration, and you will find solutions within government sponsored health care. By attempting to siderail the discussion through asserting your political biases, you are detracting from the issue. Let's get back on topic here.

      March 10, 2011 at 13:01 | Report abuse |
    • SeanNJ

      Government takeovers have nothing to do with what you describe. Insurance companies have been perfectly capable of bringing about these changes all on their own.

      Will government intervention make it worse? Probably, although it's hard to say for certain. Suffice it to say to blame the current state of health care on the health care law is....ummmm...stupid?

      March 10, 2011 at 13:03 | Report abuse |
    • ImmoralManagedCare

      If you think this is a result of "government taking over healthcare" you are a misinformed fool. I've been a practicing Psychologist for over 20 years and managed care/private health has gutted mental health over this period. At this point the best paying and most reliable provider I have is...Medicare..... And by the way, Psychiatrist are not formally trained in therapy and they stopped "talking to their patients" about 20 years ago.

      March 10, 2011 at 13:09 | Report abuse |
    • powderqueen

      Leo is indeed correct. The most likely outcome of providing UHC would be 2 systems – the government system for the elderly, the poor or those who chose it – potentially with restrictions regarding which doctors (ie some doctors may not accept it, or work at non UHC hospitals) ;and the private system for those who had more money and wanted a different standard of care (i.e. individual hospital rooms instead of sharing, private maternity hospitals etc). I am Australian and this is how it works there, and very successfully. If you want immediate, shiny bright care an appointment tomorrow, shell out the dollars yourself (not your company or your insurer). If you're not that fussed and just want to see the doc once a year for a checkup, go the cheaper route. If you're rich and you don't have private health insurance, you pay an extra healthcare levy tax per annum. And the best things about this system?

      1. It's not done via your employer, so when you lose your job, you don't lose your health insurance. This removes a huge burden from companies, particularly small businesses and encourages entrepreneurship.

      2. You can never go bankrupt because you've been in a car accident, or had a sudden heart attack.

      3. You are motivated to stay healthy because your private insurance premiums will rise if your numbers are dodgy (i.e. cholesterol, weight, blood sugar triglycerides etc)

      4. You choose your own coverage, rather then "getting what you're given" from your employer, and this coverage stays with you from one job to the next. No changing plans 🙂

      5. You're not losing salary because everybody in your company is having babies and ensuring them & their stay at home spouses.

      I am currently subsidising, through my reduced salary and profitshare, the tendendcy for coworkers to breed like rabbits. SOme have 5 kids and a stay at home wife. Seriously?? If you want to do that, fine, but don't penalise me or my company profits.

      Another note – if you want to go to medical school and are offered a position, the government will pay (for ALL of your tuition). It will be interest free, but indexed to the CPI, and once you're earning money, repay it via the tax system. Tick a box when you start your employment saying you have a debt, and an extra 5% or 10% (depending upon your income level) is taken out of your salary with your normal tax payments and goes off to repay the debt (I think it's about 3% if you're earning 30k, 6% for 55k and 9% for 90k but don't quote me). If you don't earn the minimum amount, you don't need to repay it.

      Think about how that would work in America. Seriously, cut out the middle man making money from collecting your payments to begin with, stop penalising people trying to get an education by making it interest free (but keep it indexted to the CPI so nobody loses money), and get the IRS to chase up the debt. No better debt collector!!

      Finally – I find the thought of my health, or my life saving operation or my cancer treatments being a for profit enterprise to be abhorent.

      Here endeth the rant.

      April 15, 2011 at 15:14 | Report abuse |
  3. followup

    Freud certainly had many things wrong as would be expected of any pioneer (how much did Louis and Clark really end up knowing about he geography of the continent?), but he was on the right track with talk therapy. He certainly would be rolling over in his grave, as the saying goes, to see that psychiatry has been reduced to drug peddling (and drug guessing – "try this and see what happens"). Moreover he'd highly disappointed that his efforts to bring culture out of the dark ages regarding mental / emotional distress, and to make psychiatry as much a part of medicine as treating any other part of a person – to treat the whole person – largely failed. Our culture apparently still has little interest in investing adequately in mental health. Who knows whether it ever will.

    March 10, 2011 at 10:24 | Report abuse | Reply
  4. watsonmary

    You know what You guys should stop complaining because, one the health care we have now isnt as good as it was supposed to be. also the law has just been signed so give it some time. so if u want to say u have the right to choose tell that to ur congress men or state official. If you do not have insurance and need one You can find full medical coverage at the lowest price by searching online for "Wise Health Insurance" If you have health insurance and do not care about cost just be happy it and trust me you are not going to loose anything!

    March 10, 2011 at 10:32 | Report abuse | Reply
    • Me

      "if u want to say u have the right to choose tell that to ur congress men or state official."
      I did. Made not one bit of difference. Probably because I am not a fellow millionaire politician.

      "You can find full medical coverage at the lowest price by searching online for "Wise Health Insurance" "
      Right. You can find NOMINAL insurance coverage. That means you have a policy, thus "coverage", but the policy will not pay for real health CARE.

      March 10, 2011 at 12:30 | Report abuse |
    • Eugene

      Or you can visit the site of No Medical Life Insurance company https://nomedicallifeinsurance.ca/ and find here all the insurances you want for an affordable price

      April 6, 2017 at 05:45 | Report abuse |
  5. Elle

    I am fortunate enough to have a psychiatrist who gives me my medication and sits down with me for 45 minutes a week for therapy or more if I need to speak with him. The doctor I had before him would see me for 5 minutes if that, he would ask how are you feeling okay here's your prescription. Then I would have to speak with a psycologist weekly. If the psychiatrist saw 1200 patients in a year just once he would have made about $90,000.00. My insurance paid him $75.00 a visit, and I saw him at first every other week then once a month. Imagine if he saw patients every 5 to 10 minutes everyday of the week. He sure is making a lot of money. My health plan does pay out a decent amount of money and i know not all insurance pay that kind of money, but even if he was getting $45.00 per visit for 5 minutes, that a lot of money.

    March 10, 2011 at 11:10 | Report abuse | Reply
  6. Actual Therapist

    OR...you could just find a psychologist and have him or her coordinate with the prescribing physician. It's not that hard, people!–just sign a release and they can talk and you get the best of both worlds.

    March 10, 2011 at 11:14 | Report abuse | Reply
    • RoadRunner, Albuquerque, NM

      Excellent suggestion. A Psychologist, a Licensed Social Worker, or a Licensed R.N., are certainly co-professionals specifically trained to provide adjunctive therapy in tandem with a Psychiatrist, at a far reduced cost to patient or provider (third-party payer).

      March 10, 2011 at 13:05 | Report abuse |
    • CM

      Exactly what I did. My therapist never starts on time because he always runs over his hour – for all of us. He gives me his full, undivided attention for a full 60 (+) minutes. He has helped me more in 14 months that any shrink that I have seen. I would recommend a psychologist over a psychiatrist any day....and yes, they will work with your GP if you need meds. My therapist is up-to-date on his meds knowledge and works hand-in-hand with my doctor.

      March 10, 2011 at 14:05 | Report abuse |
    • VishaNu

      While I agree with most of what you say here, I would warn anyone suffering from a mental illness like bipolar or depression not to rely on a GP to diagnose and prescribe the correct meds. In my experience, the GPs are into prescribing the "latest and greatest" pills out there without giving a second thought to the chemical levels on which certain meds work or the adverse effects of not following the proper step-down procedure from one pill to the next. A loved one ended up being taken into emergency protective custody against her will because the prescribing physician - a GP - didn't bother to do her homework. We ended up with a $3,500 hospital bill and having to explain to employers why my loved one was led out of a doctor's office in handcuffs in our very small town.

      March 10, 2011 at 15:17 | Report abuse |
  7. Dr Bill Toth

    It has never made sense to me how taking drugs and dwelling on the past can result on a better future. Seems to make more sense to focus on what people did to successfully move forward after life's many "adventures". Live With Intention, DrBillToth.com/blog

    March 10, 2011 at 11:29 | Report abuse | Reply
    • Sarah

      I hope you are not a psychologist, "dr."

      Plenty of people need to work through the past/use medication IN ORDER to move forward after life's many "adventures," as you put it.

      Everybody needs help, now and then, and some of us need it more than others. Why, perhaps if you sat down with someone and talked about YOUR past, you may even be able to get to the root of your display of judgment, lack of empathy, and shortsightedness toward those with mental issues? There has got to be a root cause somewhere. Blessings and food for thought to you. 🙂

      March 10, 2011 at 11:43 | Report abuse |
    • VishaNu

      Wow. Dr. Bill...your ignorance about mental illness is staggering.

      March 10, 2011 at 12:31 | Report abuse |
    • masimonson

      Probably a chiropractor, for some reason they love to call themselves doctor.

      March 10, 2011 at 12:40 | Report abuse |
    • followup

      Something like 40% of medical doctors do not believe in counseling or therapy and perhaps Dr. Bill Toth is in that camp. They believe instead, ironically, in their own efficacy through doing drug experiments on their clients.

      March 10, 2011 at 12:56 | Report abuse |
    • CM

      Holy cow. Your ignorance about mental health issues is unbelievable, "Dr." Toth. Is your PhD in underwater basket weaving or something?

      March 10, 2011 at 14:07 | Report abuse |
    • CalgarySandy

      Very few mental health workers think you should wallow in your past. The focus is on coping in the current time and healing the damage that was done in the past. If you are saying your brutal childhood or cascade of catastrophes are irrelevant to who you are today you are no Dr. Who we are is the outcome of who we were and how we were treated before our brains were fully developed. It basically requires long term analysis to discover what, if anything, helped you move forward and then build on that. It requires retraining the plastic brain and that takes a long time with a Dr. who does not think his words of wisdom should cure you. There is no silver bullet with mental illness and it is extremely unkind and unprofessional to say that all they have to do is look at successes. That does not change the physical state of the brain that is the cause of all this. It is physical and not merely moodiness. And then there are the people who have gone through unthinkable things for so long they cannot find a success.

      March 16, 2011 at 16:25 | Report abuse |
    • Bob

      I somewhat agree with Dr. Toth. The reason the human brain has more capacity than other animals is that it allows them to more accurately predict how their actions will impact their well being well into the future. We don't know how far ahead a dog can think but it likely more than a minute – it is certainly less than a day. Humans can look a head years. If we look only to the past we cease doing what we evolved to do. The best way out of this is to help the client understand that the past hurts were not his/her fault nor were they the fault of anyone else. It may help to understand what happened in the past but all parties must be forgiven in order to change focus to the future. Until the client can change his/here focus to the future the client can not be considered healed. However, this will never happen if we continue to blame the client for his/her problems.

      April 10, 2011 at 14:11 | Report abuse |
  8. Sam

    Psychiatry has made my life a sick joke with the medications they gave me when i was 17. I have never been the same. They are criminals in my mind.

    March 10, 2011 at 12:11 | Report abuse | Reply
  9. NBE

    An auto-mechanic, or somebody who "feels" like one, is hardly the right person to see for psychological trouble, illness, etc.

    However, if you do call one of these hotlines, be aware that they are set up to trace your call, get your address, and send the police to your door. If you doubt this, volunteer, take the training, and see for yourself.

    March 10, 2011 at 12:16 | Report abuse | Reply
  10. R. CHARLES

    I AM A PSYCHIATRIST. TAUGHT FOR 30 YRS AND ENJOY LISTENING AND TRYING TO PIECE TOGETHER THE ORIGINS OF MY PATIENT'S PAIN. PASSING PILLS ALL DAY WOULD BORE ME SILLY AND I DON'T SEE PATIENTS WHO ONLY WANT THAT.

    I'M NOT THE ONLY ONE WHO PRACTICES THAT WAY BUT PERHAPS WE ARE BEING OUT DATED. MINE DO WELL – KNOWING SOME THINGS DOES INDEED HELP.

    RC, M.D.

    March 10, 2011 at 12:22 | Report abuse | Reply
  11. ash

    I was diagnosed with depression and put on pills for ten years. When I went in for a different test, I found out that I never had depression, but a thyroid problem- and the antidepressants made the problem worse!
    Before you let a psychiatrist put you on ANY medication, be sure to get a blood test to check for other problems first.

    March 10, 2011 at 13:27 | Report abuse | Reply
    • KellyinCA

      @ash, it makes sense to rule out any changes in physiology before seeking mental health care. However, the problem in such cases is that the patient seeks primarily to receive treatment for the symptoms without considering the underlying causes. The ideal situation is for the patient to see their GP (who should know their patient well enough to bring up possible causes), then to be tested for any possible physical causes. Then, if the test results warrant it, the customer can then be referred to the proper specialists, including psychiatrists. Alas, many Americans seem not to have a GP or to be able to see one on a regular basis, so the footwork may not be done properly when the patient reaches the couch.

      March 10, 2011 at 17:01 | Report abuse |
    • Shannon

      Sam, I experienced the exact same problem! However, once my thyroid issue was diagnosed, my psychiatrist CONTINUED to prescribe me pain medications, yet was thoroughly confused when my TSH levels continued to spike. Ultimately, it was up to me to discontinue my depression medications, and now I am doing much better.

      March 11, 2011 at 04:36 | Report abuse |
  12. Sob

    "At the same that psychiatry moves away from an all-encompassing approach to treatment, psychiatric problems are on the rise in the United States."

    At the same what? Time?

    March 10, 2011 at 13:51 | Report abuse | Reply
  13. SD

    I totally agree with this article. I see a therapist regularly and she recommended that I should go on meds but she can't prescribe them. So I had to then get permission from my insurance to see a psychiatrist. None of the ones who were "permissible" were anywhere near where I live. I finally got one thats at least in a 20min range. My insurance company and I spend money so I can see the pyschiatrist for all of 15 min. While they prescribe the meds that my therapist recommended. Its such a waste of my time and ridiculous how much $ it costs to spend 15 min with a person so they can prescribe me meds even though they really don't know the issues as fully as my therapist.

    I really think the way we train mental health professionals in this country is flawed. Train them to be able to do therapy and prescribe meds. Why are we separating these things?

    March 10, 2011 at 15:25 | Report abuse | Reply
    • ViviMack

      they are separated b/c they are two different fields. like Accountants...some do audits other do taxes still others do business financials...all called accountants. A good med doc isn't always a good talk doc. Two different degrees entirely!

      March 10, 2011 at 15:40 | Report abuse |
    • OldPhysio

      SD: See comment above about missed dx on thyroid problem. That's unexcusable for a doc because a good shrink should first rule out medical/toxicology/pharmacology causes of psychiatric symptoms and signs before starting meds. If a psychologist wants to do this, they should go to med school. There is a very important role for psychologists, but dx'ing medical issues is not one for which they are trained.

      Overall comment: medical care is like everything else - we get what we pay for. The efficiency of the private sector is another Ponzi scheme foisted on the public - tell me the last time you called your managed care company, computer maker, cell phone company, airline, etc., and got good service. The exceptions are rare (maybe Costco and a few others), but we bring this on ourselves because all we do is look at cost. When our love affair with the idol of "low tax" finally kills our infrastructure (physical, educational, R&D), we can plan to become serfs of agribusiness and grow food for the rest of the world.

      March 10, 2011 at 16:01 | Report abuse |
    • CalgarySandy

      You can call yourself a psychologist with only a 4 year degree that is not in medicine. A psychiatrist has to go to medical school and become a medical doctor then they do their specialization in psychiatry. Undergraduate Degree 4 years. Medical school = 4 years, Psychiatric Residency (I.e. the specialization after becoming a Medical Doctor.) Part of their job is diagnostics. They are meant to be able to recognize a neurological disease as well as the mental illness ones. Science is showing that it is all neurological and I wish the move to neurological studies would lead to some help for the ill.

      I have several very bad Psychiatrists. No matter what. I do not want anyone who only has a 4 year degree in psychology or social work prescribing drugs to me. Nor do I want them diagnosing. I have had bad luck with them and with psychiatrists. I can get my health care plan to send me to the pshrink forever but psychology is limited and of very little use in chronic and complex disorders.

      I am hoping that neurology will soon be able to help. They at least can take a picture to see where the problem is rather than just keep throwing different meds at it and piling one med on top of another. The genome work being done is wonderful but offers little promise in the short run.

      March 16, 2011 at 16:52 | Report abuse |
    • CalgarySandy

      Oops. The psychiatric residency is also for years. That is 12 years of training. You psychologist is most likely to have an MA or MSc. You can usually get that in a couple of years after your first degree.

      March 16, 2011 at 16:55 | Report abuse |
    • yikes...

      CalgarySandy,
      One with an MA or MS is not a psychologist, and if they refer to themselves as such that's another issue entirely. Psychology training is quite similar to, and in some manners more extensive (as a great deal of my psychiatry colleagues have noted), than psychiatry training. One quote that stands out: "wow, we just have to pass a few tests and not kill anybody and we're doctors, you guys have it much rougher." Undergrad = 4 years, Doctoral = 4 years, internship = 1 year, residency = 2 years...so, there's 11 there compared to the 12 of a Psychiatrist. And what, exactly, do the "pictures neurologists take" tell us about mental disorders? If your answer is "nothing" then I will agree

      March 29, 2011 at 00:55 | Report abuse |
  14. debi

    I am a licensed mental health counselor and those holding Masters degree in this or similar fields are extremely capable of and maybe better trained in "talk therapy" then most Psychiatrist are. The article omits that there are other well trained professionals that patients/clients can talk to while the Psychiatrist oversees their medical managment.

    March 10, 2011 at 17:07 | Report abuse | Reply
  15. MichaelN

    I have been working with therapists since I was diagnosed with depression in the early 1980's. Even then, it was entirely out in the open that most psychiatrists were too busy working with patients needing medication to maintain any kind of therapy practice. Furthermore, because a psychiatrist has to be an MD first, they are selected by the medical school process, and it is not news that the technology and science bias to that training is an obstacle for any one to maintain, let alone develop the emotional capacities crucial to an effective psychotherapist. There are plenty of psychologists with Ph.D.s and master's degrees who are superb with the aspects of purely psychological development that neither needs nor can be effected by meds. I have experience in this area and frankly I would never consider or recommend a psychiatrist for therapy.

    March 10, 2011 at 17:17 | Report abuse | Reply
  16. Brian

    From my personal experience psychiatrists aren't interested in your problems, they just want to know how you're feeling and give you a drug. Sometimes the drugs do work though.

    March 10, 2011 at 17:20 | Report abuse | Reply
    • Brian

      I should also note that if not for psychiatry I would probably be dead.

      March 10, 2011 at 17:21 | Report abuse |
    • CalgarySandy

      Some of them get really snotty if you do not respond to the meds as if you are even able to override their effects. I usually get th horrific side effects with out any benefit. Still, without acid when I was younger and being a Mom I would have killed myself years ago. Now I am hanging on to threads as the meds still are not working and my azzhole of a psychiatrist up and left town. No one is taking patients so I have to do the med work myself with my family doctor supporting me on it. I wonder how many people have to do this. At least my GP does have a good education, is not an arrogant cow who thinks she is god, and does keep up. If I present with something she is not familiar with she finds out.

      March 16, 2011 at 17:00 | Report abuse |
  17. Caljax

    Point was the health care system is set up to where if a psychiatrist "talks" insurance companies, government doesnt want to pay..limited access AND then they will come after the doctor for fraud for something they deem medically unnecessary...so there are a lot more problems with mental health than just psychiatrists don't "talk" to patients. Besides These days when do you even see the doctor...I get NP and midwives...and just the docs signature. And in that system docs will become vulnerable to fraud claims..just a warning..thanks

    March 10, 2011 at 17:21 | Report abuse | Reply
  18. Mondo

    You really need both a psychiatrist and a psychologist if you have mental problems. When you get a good set that work together, it is like a stronger safety net to help catch you. One may miss something that is blaring obvious to the other than they will at least send a quick email to the other to screen you for this. My docs probably over prescribed me meds, but it's better than what i have to deal with now that i have no insurance and no job and I have to go through the VA. They are convinced that everyone who comes in and doesn't have PTSD is a drug abuser and underprescribe.

    Solving mental health problems are FAR different than fixing a broken ankle or even a bodily infection. It requires counseling, meds, and patience. It's not snake oil and mirrors.

    Yet, the biggest problem with having both docs is that when i had actually very good health insurance they would only pay for 30 visits (combined with both) for the year, yet they had no problem eating the costs for basically $1k a month in prescriptions. Anyone who is bipolar knows this is like paying for for all of a cancer patient's meds, but only paying for 2 out of 3 chemo sessions. Luckily, both docs I had were great and worked with me to allow me to pay a small percentage above my normal co-pay even when my insurance ran out.

    March 10, 2011 at 19:58 | Report abuse | Reply
  19. survivor

    The psychiatrists just figured out that there is nothing to examine, that's why they don't listen to anything. Here is the truth, if you beleive that one plus one equals two, and a psychiatrist is a retarded alchoholic he will diagnose you insane because he is insulted by facts and logic and because he is too retarded to get it himself.

    March 12, 2011 at 08:38 | Report abuse | Reply
  20. Altostrata

    Posted April 1 on SurvivingAntidepressants.org:

    1 April 2011
    Dubuque, Iowa
    Health Insurance Times

    Health industry group: Replace psychiatrists with vending machines
    Measure to reduce health care costs

    1 April 2011 (Dubuque, Iowa) A health care industry thinktank, US Health Insurance Consortium on Cost, advocates replacing psychiatrists and other doctors with vending machines to prescribe and dispense antidepressants.

    "We believe this will cut the cost of psychiatric services significantly," Uli Arnowsky, spokesperson for USHICost, said. "Our studies show the diagnosis and prescription process can be automated, with no loss in quality of care. Specialist costs are just not necessary for this type of treatment, and psychiatrists are overworked anyway."

    USHICost's plan is to make the Psychiatric Diagnostic Screening Questionnaire (PDSQ) available online to health plan members. Answers would be captured in a database and analyzed to produce a recommendation for a prescription. A psychiatric nurse reviews the recommendations and authorizes the prescription, which is then attached to the patient's database record.

    Vending machines, in convenient medical center locations and on a secure network, would be stocked with the most common generic antidepressants.

    "We prefer the generics," Arnowsky said. "They're part of the cost-cutting. Our studies show they're just as effective as the name-brand drugs."

    According to Arnowsky, to get a prescription filled, a patient would input a health plan ID and a password at a vending machine. The machine would look in the database, dispense the authorized prescription, and charge the copay to a credit card on file in the patient's health plan record.

    "We really like the way this system keeps electronic medical records, too," Aronowsky said. "It's a win-win-win for all concerned."

    Patients reporting side effects would be advised to see their doctors, who could then adjust the prescription if needed.

    "There's a lot of trial and error in prescribing antidepressants already," he said. "This system is no more error-prone than present prescribing practices. In fact, we put fuzzy logic in the system to rotate prescriptions among the antidepressants, because we've found doctors prescribe them in an almost random fashion. We built the human element right into the system - it thinks just like a doctor about these drugs."

    He stated that USHICost's studies had shown diagnosis by PDSQ was at least as accurate as by doctors, including psychiatrists. "This will take a big burden off primary care physicians, too, who are bearing the brunt of prescribing antidepressants," he noted.

    April 2, 2011 at 17:22 | Report abuse | Reply
    • Bob

      I think you got fooled into believing an April Fools joke.

      April 10, 2011 at 14:21 | Report abuse |

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