I was delighted to see it:
The psychiatrist is on to something.
Oh, I’ve been there before. In various ways, in various formats, I’ve made the argument that it usually takes a lot more than drugs to help somebody who is suffering from anxiety, depression or wild mood swings.
And if you’ve battled mental illness yourself, you know that Dr. Daniel Carlat didn’t discover the cure for schizophrenia or any other serious mental illness.
But there it was, all laid on in a briskly written narrative by a respected expert. And published in The New York Times Sunday magazine no less.
Treating a patient he calls “J.J.,” Carlat realized that he was merely asking the patient about his symptoms. So the goal was to match the symptoms to a medication.
Think about it. This is exactly what your pharmacist does. No search for causes, for context, for an understanding of the person. Since the psychiatrists threw out Freud and psychoanalysis, they’ve been reduced to pushing pills.
Often, patients get better. Or seem to. And the doctor might refer the patient to a counselor for talk therapy.
What Carlat is forced to acknowledge, though, is that in the formal tests of the psychotropic drugs, the placebo can be just about as effective as the medication being tested.
This is fascinating stuff. Somehow, the brain changes itself when you think you’re getting an active medication. In reality, you’ve been duped. It’s a dummy pill.
Of course, the changes still are brain chemistry. But a person’s thoughts and feelings have an impact that now can be seen in a PET scan. Indeed, when you get angry or jealous or afraid, your brain chemistry changes.
Exercise, too, gets the brain chemistry going.
And when you introduce talk therapy, you can find even greater brain chemistry changes. Not always maybe. But often.
As a practical matter, we probably won’t see psychiatrists moving out of their role as highly trained pharmacists, mainly matching symptoms to meds. These doctors’ time with each patient usually is quite limited. Too little to go deep. And there are too few psychiatrists to go around.
In his Times article, Dr. Carlat says he got into psychiatry for personal reasons, much of that harking back to his mother’s suicide. He didn’t know what medications if any she had been on at the time of her death. But he is right to wonder. What if she’d had the right kind of therapy? What if she had the kind that allows a person to transcend their fears and sense of hopelessness? Just maybe her life could have been spared.
Very often, the right prescription for mental illness doesn’t come in a bottle.