Where Have All the Psychiatrists Gone?


Do some people become doctors just to earn a lot of money?  Yes.

Sigmund FreudDo some of them find out that it’s not as lucrative as portrayed in the media (based upon stereotypes at least 40 years out of date)? Hell Yes!

Psychiatrists are not normally schizophrenic — however there are two types.  One is the media stereotype “Talk Therapy” doctor.  These are nearly extinct. They exist mainly in Woody Allen movies and old TV series.  In fact, most of those are psychologists — not psychiatrists (but who knows the difference and who cares?).

The other type is what you chiefly find today — Pill Pushers.  Insurance and

government programs pay most of the bills and they won’t pay for long-term couch-lounging and dream recalling. They will pay to give you a pill and get you up and running — or get you zonked out and passive.

Like the old joke says — most people are whores; it is just a question of naming the price.  Why not doctors too?

The psychiatrist interviewed in the NY Times — and he does sound like a fairly decent fellow — says he can only do drug therapy.  He cannot change to a talking practice that pays less because he and his wife want to maintain a certain lifestyle in retirement.  He just pushes drugs and says it is not that hard.

Let me tell you, it is hard if you do it right. I’ve done it for more than 20 years and never killed anyone, never got sued and never had the DEA yank my license for diddling with the drug inventory.

The scary part is that most drugs now used in psychiatry have not even been around long enough for long term side effects to be known.  I have yet to meet a doctor who — like myself — understands the responsibility of reviewing the advantages and risks of psychotropic drugs with a patient.  Drugs which occasionally kill people, prior to writing a prescription for same.

But moreover, there is something called a “meta-message” – or what is communicated, but is not said.  A patient with panic attacks gets a prescription for antidepressants, thinking that is all that he needs. So she believes that whatever problems she has in life come from some kind of biochemical glitch; the “chemical imbalance” that patients say they have that is not their fault.

I have my own classic explanation of the “fight or flight” syndrome.  It’s about Fred Flintstone seeing a saber-tooth tiger and having to decide whether to clobber it or to run like hell.  Maybe people could have better lives if they could learn what their “saber-tooth tigers” are.

Like panic attacks.  Relaxation training can diminish panic attacks or maybe even get rid of them without drugs.  When do the panic attacks happen?  If someone journals this they may find out why, and be able to do a better job of dealing with the major conflicts in their life.

Projections need to be made when writing a prescription, like how long the patient may need the drugs and when to try to get off them.  The projection can be made as a function of the patients’ age, with current knowledge.

The field I chose, after knocking around in several others, has been decimated.  All talk therapy has been delegated to lower-credentialed folks.  Not usually PhD anyore — mostly Masters-levels but with quite a few Bachelor’s degrees and some vo-tech type of things like certified drug counselor.  Even worse — I’ve been in situations where there are “peer counselors.”  In other words, to be a therapist, you have only to be a patient (and not necessarily cured or detoxified).

Of course — this is all in the way of lowering costs and saving money.  Who cares about health and well-being?

This is despite the fact that it has been shown, time and time again, that many psychotherapy patients get better when they have both a desire to get well and the belief the person treating can make them better.

I’ll bet there are a lot of people accepting whatever insurance pays for while going 0 for 2. The New York Times did well to pick this psychiatrist for study.  After all, he’s one of those guys who tries to look like Freud.  Most people will accept an older male if he is bald or white-haired and has a little beard.  I’ll bet a lot of these professionals cultivate a Viennese accent too — just like in the movies.

The complaint that doctors do not speak to patients any more is a valid one.  When I was in residency, I remember being told that the average family practitioner interrupts a patient after less than 30 seconds and ends a visit in seven and one half minutes, so we had to be better listeners.  I tried.

But the tyranny of time is, in effect, the tyranny of money.  He was amazed people respected him, with the rapidity of the interaction. In other words, there really are still some folks around who know how to help people get better just by talking to them.  We are no longer paid for it, so my guess is people with problems who can’t tolerate or don’t want drugs are not doing a very good job of getting better.

I have always believed in talk therapy as a great and powerful tool.  It was invented by Freud and it has worked for a very long time.

The business aspect of “medicine” has stopped us from using it, effectively or well, if at all.

But hey, at least most psychiatrists can still count on a certain lifestyle in retirement.

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