The new Psychiatry: "pull out the prescription pad"

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MShep2's picture

Quote:
The switch from talk therapy to medications has swept psychiatric practices and hospitals, leaving many older psychiatrists feeling unhappy and inadequate. A 2005 government survey found that just 11 percent of psychiatrists provided talk therapy to all patients, a share that had been falling for years and has most likely fallen more since. Psychiatric hospitals that once offered patients months of talk therapy now discharge them within days with only pills.
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.
This is exactly what most nouthetic counseling teaching says, but which has been poo-poo'ed by some. I am sure there are good psychiatrists out there but now with the pressure from insurance companies "talking" doesn't pay. Prescribing drugs does.

MS
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Luke 17:10

PLewis's picture

It's very confusing to those of us who have to deal with friends / family members that are diagnosed with mental illness. Whether it's "true" or not the fact of the matter is when folks get on the medicine merry-go-round it's a constant battle.

I truly wish I could find a Christian doctor who could advise from a biblical standpoint .. but how do you find them? It's a constant battle .. I have two such folks in my life right now that always seem to turn to me for support .. and yet finding that balance between being compassionate and being "tough" is hard ..

I gotta tell ya - when you hear the side effects of "anti depressants" and they include "thoughts of suicide" it's just bizarre..

PLewis's picture

Can't say I ever heard of her .. but yeah .. even those in the world are seeing the foolishness of it.

The thing that's horrible is often by the time you realize there's a "problem" .. there's a COMPLETE breakdown - and when THAT happens they're put on the Merry-go-round ..

Bob T.'s picture

This is one reporters story. It has truth but appears to want to find the worst and be some sort of advocate for better care. We can always use better care. What is seen here is now typical of much of all kinds of Medical care.

Praise God that the basic premise of this article is very true. Psychiatry has done what it should have done from the beginning. It has adopted the medical model of diagnosis and treatment. For those Christians prepared to speak from their ignorance on this- please refrain. The really sad fact is that many into so called "Biblical Counseling still think Psychiatry is dangerous because it is following the Freud and post Neo Freud models of treatment. This article acknowledges that is not so. This change has gradually occurred as Psychiatric medicine gained factually based medical knowledge of mental illness. Genuine mental illness is "Brain disease" and no one afflicted with it can be talked out of it. On the other hand Psychiatric medicines have been developed that work. This means that the Schizophrenic, Bipolar, Asberger disease, and other "victims" can be somewhat normalized and functional without being institutionalized. Most Biblical counseling books often give forty year old quotes from Thomas Sasz and other Psychiatrists to prove how terrible the profession is. Others talk of a Physician referral to a general or family practice Physician for a check of the physical aspect. Of course the non specialist knows virtually nothing of modern Psychiatric diagnosis and treatment.

The actual treatment is not always like this article indicates. First, most all with genuine mental illness are treated in a county or state clinic or in a practice that will take Medicaid. The course of diagnoses and treatment includes an extensive interview by a Psychiatric nurse or other trained assistant. This is then given the Psychiatrist that then goes further in his first patient encounter which may take 45 Minutes or longer. Medicine may then be prescribed and will be followed up that week by the Psychiatric nurse. If the medicine is effective then there will be a patient visit every 30 days. These may be later reduced to every 90 days. Medicaid will only pay a very small amount. The doctor must agree to take this as full payment to be on their list.

There is a big problem with cost. Psychiatrists go through medical school then three years of post graduate, and then internship and residency. They are entitled to a descent living. Private practice is expensive. Some Psychiatrists do set up practices in wealthy areas and end up treating non mental illness maladies and a few mental illness cases. They often only take private payers. Those who practice in the public arena through clinics or Medicaid do so at some sacrifice. Most diagnosed with mental illness are disabled. They cannot work or only part time. They end up on SSDI (Social Security Disability) or on SSI if not eligible for SSDI. They also then go on Medicare or Medicaid or a combination coverage. All their treatment is then covered by what Medicaid will pay. It is not much. The Psychiatrist in practice who has a majority of such patients must rely on a certain volume to gain practice income to support his office, Psychiatric Nurse, other assistants, insurance and equipment. However, treatment is not unlike other medical practice today. All preliminary tests and interviews are done by an assistant. You spend little time with the doctor. I have been through Cancer twice, have heart problems requiring regular lab work, and am now Diabetic. My wife and I know how regular medicine is practiced. Psychiatry is medicine practiced in a normal matter. Some Psychiatric treatment involves Brian scans and other diagnosis. I have run into several Psychiatrists holding the MD and also a PHD in Biochemistry. This is not your 1960s and 70s Psychiatry that sought to blame the mother and childhood for Schizophrenia and then talk to the patient in endless therapy seeking to cure the patient. The Physiological disorders are now recognized and are treated medically just as the heart, kidney, or diabetes is treated with regular medicine. I take 10 pills a day for Diabetes and Afibrillation of the heart. Why are Christians so ready to criticize the treatment of Brain disorder with medicine? Part of the problem may be the Pastors and Theologians having a need to be authoritative on anything having to do with behavior, mood, or social interaction. They often speak with authority about that which they know little about.

Please do not include depression in with genuine mental illness caused by Brain disease. Some depression has a Brain disease cause but most who are treated with such diagnosis cannot be so classified. Yes, some statistics show that peer counseling, exercise, and Psychological counseling alleviates the majority of depression cases. They do not need medication. Some are often over prescribed by the general practice Physician. Unfortunatly, the Pastor or Theologian may use such findings as pointing to the lack of validity of Psychology and Psychiatry. There is little valid application. The Christian should probably reject many of the historic and present theories of Psychology and Psychiatry. But it must be done with the utmost care. Both disciplines now offer objective scientific truth that is true and useful. The Bible is fully sufficient in all that it speaks to. This does not exclude other truth that is neither contrary to or included in scriptural revelation.

Please understand where mental illness fits in Biblically. The "mind" in the NT is generally seen as an aspect of the immaterial soul. Therefore, the mind cannot be physically diseased. However, there is never a time in our lifetime when the mind and soul do not operate with and through the Brain. If the Brain becomes damaged the mind cannot properly express itself and operate. There is no such thing as Mind disease. There is such a thing as Brain disease. The mind and Brain together do the "mental process." When the Brain is diseased this process changes. This abnormal mental process is what we call "Mental Illness." There is not "Mind illness" but there is "Mental illness."

We have started "The Christian Alliance on Mental Illness." The purpose is to inform and help the mentally ill and those who are the caretakers of the mentally ill. We wish to do so from a Biblicist Christian perspective. We uphold the need and effectiveness of genuinely Biblical counseling in many aspects of our lives. We also uphold and affirm the medical concept and diagnosis of Mental illness and the need for treatment, like all physical illness, with the true knowledge gained by Psychiatric medicine. We thank God for all medical advances as being from Him. We thank God for those Psychiatric medical advances and medicines and treatments that have brought hope to the victims of mental illness - Brain disease. We will soon have a web site up and running.

Bob T.'s picture

This reporter stated:

Quote:
A psychiatrist can earn $150 for three 15-minute medication visits compared with $90 for a 45-minute talk therapy session.

As I stated in my post above, most genuinely mentally ill are on disability with their Psychiatric care paid for by Medicaid. Medicaid pays a fraction of the above rates. And it goes to the practice or county clinic not the personal profit of the Psychiatrists. The reporter leaves out several non Psychiatrist involved steps to diagnosis that involves the Psychiatric nurse and social workers interviews and intervention.

Is this our typical biased shortcut reporting to create a more sensational story?

Bob T.'s picture

PLewis wrote:
It's very confusing to those of us who have to deal with friends / family members that are diagnosed with mental illness. Whether it's "true" or not the fact of the matter is when folks get on the medicine merry-go-round it's a constant battle.

I truly wish I could find a Christian doctor who could advise from a biblical standpoint .. but how do you find them? It's a constant battle .. I have two such folks in my life right now that always seem to turn to me for support .. and yet finding that balance between being compassionate and being "tough" is hard ..

I gotta tell ya - when you hear the side effects of "anti depressants" and they include "thoughts of suicide" it's just bizarre..

First, most of the problems with anti depressants have come from general practice Physicians prescribing them. As an example, at the LA county Mental Health clinics here they are very leery of them and will often alleviate the depression aspect with general anti psychotic medicines. They are prescribed very sparingly.

All genuinely mentally ill patients get on the so called medicine merry go round. However, that is something to praise God for. Such medicines, like heart medication, may be needed for the rest of their life. But it is all that keeps them from being in an institution. We care for a Schizophrenic who has been institutionalized five times because they went of their medication. Each time was but for a few days. It was necessary because their behavior became extremely Psychotic. This is typical. The medicine is to no more be damned that insulin or pills for the diabetic. You do not need advice from a Biblical standpoint any more than a Cancer patient must go to a Christian doctor. It is great if the Psychiatrist is Christian but if he is not a good Psychiatrist it can be worse. I speak here of genuine mental illness not just general depression. Although some general depression can be physiological.

I am thankful for the Cancer, heart, and Diabetic merry go round in my own life.

Christians generally are thankful for all our medical advances and medicines. However, when it comes to Mental illness or Psychiatric medicines they go into general medieval non scientific darkness and decry the medicines and the evil pagans distributing them and are sure the answer must be spiritual. Not too far from Puritan Witch trials due to a wrong view of spirituality and humanity.

I do not know your particular situation but we will pray for you at our support group.

rogercarlson's picture

I am just going to speak from my years of experience, as a pastor and a Chaplain (hospice, police, and fire dept). Like Bob said, for the truly mentally ill, medications are needed. This is an area that many in the Biblical Counseling Model did not acknowledge (myself included). I think that is changing. As believers, we need to treat someone with a mental illness similarly as we would someone with another medical ailment.

For caretakers, you need to be an advocate for the patient. Bob, is right in that the people going into the mental illness profession do so because they want to help and are often willing to do work that most believers are unwilling to do. But these people do make mistakes and often do. This is especially true in my area where our poverty is extremely high. Over half of the students in our local schools are on free or reduced lunches. Of course, the majority of those families would then also be on some sort of food asistance and of medicaid too. Those people in the mental health field here do not get wealthy. But these people do make mistakes.

Some times they are quick to not allow someone a an observation bed, eventhough they were deemed a danger to themselves and/or others by police and other medical professionals. Sometimes patients are put on psychotropic drugs because it is more conventient on the group home worker to have a person non-interactive in their room then having to listen to the conversation over and over again about aliens. Through the Lord's intervention, another psychiatirst was placed at the health department and changed the plan. But what ultimately helped the people that I have just spoken of, was a caretaker humbly, compassionately, yet persistantly asking questions of the medical staff.

Roger Carlson, Pastor
Berean Baptist Church