This weekend’s Sunday New York Times Magazine carries my article, “Mind over Meds,” in which I argue that psychiatrists should reclaim the skills of psychotherapy. Compared to many of my writings, the article is not particularly controversial, and I think most readers would agree with the main points.
However, the following statement from the article has generated a number of indignant e-mails:
“Like the majority of psychiatrists in the United States, I prescribe the medications, and I refer to a professional lower in the mental-health hierarchy, like a social worker or a psychologist, to do the therapy. The unspoken implication is that therapy is menial work — tedious and poorly paid.”
Several psychologists have pointed out that their work is just as valuable as the work of psychiatrists, and that they are surprised that I would consider then “lower” in the hierarchy. Actually, my point here got muddled, and it was just the opposite. Many psychiatrists have an elitist attitude toward psychologists, falsely believing that therapy is somehow less valuable than psychopharmacology. This view is reinforced by the fact that insurance companies pay less for therapy than for psychopharm visits. The view also stems from the fact that some psychiatric illnesses, such as schizophrenia, respond much more robustly to medication than therapy.
However, for most psychiatric problems, the dichotomy between therapy and medications is overblown. Both meds and therapy are crucial. The ultimate mental health practitioners, in my view, should be equally skilled at both psychopharmacology and psychotherapy. Unfortunately, there are very few practitioners who can offer the full package. Because of this, most patients have to see two professionals, one for therapy and one for meds. That’s a crazy system, and Unhinged (the book upon which this article is based) expands on this problem and offers a menu of solutions for solving it.