In last weeks NY Times magazine, an article written by Daniel Carlat, M.D., entitled Mind over Meds http://www.nytimes.com/2010/04/25/magazine/25Memoir-t.html?pagewanted=1, raises the hotly debated issue of the value of psychotherapy versus the value of psychotropic medications for treating mental illness. It also raises the issue of the unfortunate state of mental health care that is provided in this country.
Dr. Carlat, a psychiatrist and associate clinical professor of psychiatry at Tufts University School of Medicine, discusses that after several years of practicing he has come to the realization that to effectively treat his patients it is necessary to do more than simply diagnose and dispense medication, but also get to know them and provide supportive psychotherapy. I support Dr. Carlat’s comments and the initiative he has taken to speak out about this very important topic. I hope that his article is one of several efforts that are made by the field of psychiatry to evolve beyond merely providing medication for the treatment of mental health issues.
Nonetheless, I find it disturbing that getting to know and understand one’s own patient instead of trying to peg them into a diagnostic category would be a revelation or a novel concept. Beyond the fact that the efficacy of psychotherapy has been long established by countless studies (either as an alternative or in conjunction with psychotropic medications), it is common sense that mental health professionals need to know the patient sitting in front them in order to provide effective care.
Dr. Carlat’s conclusion that psychiatry needs to assume a more holistic approach that incorporates supportive psychotherapy is certainly a step in the right direction, but it does not address the underlying issue. Specifically, the “disease model” that is prevalent in our culture emphasizes treatment of pathology rather than promotion of healthy living. It is a reactive approach that simply strives to reduce symptoms. By adopting a preventive model to mental health we can reduce the incidence and severity of mental illness, improve the overall well-being of our society, as well as cut the costs necessary to treat these diseases by drastic amounts.
Moreover, there is an abundance of research, such as findings from the burgeoning field of Positive Psychology http://www.ppc.sas.upenn.edu/ppprogressarticle.pdf, which demonstrate that by identifying and fostering individual strengths/talents we can not only alleviate suffering but also enable people to achieve more fulfilling and meaningful lives.
Dr. Marc J. Shulman is a clinical psychologist and founder of Positive Living, a series of workshops which applies a cutting-edge scienctific approach to helping people achieve happiness, success and fulfillment. He is also the publisher of www.goodlifematters.com, a blog which promotes a proactive approach to wellness through science and policy. Dr. Shulman served as a Research Scientist at Yale University and maintains a private practice in Long Island, NY. Learn more about his work at www.positiveworkshops.com and subscribe to his FREE E-newsletter.