There's an article in the NYTM written by a psychiatrist about his transition from asking a checklist of questions and then prescribing the drug most likely to work to sometimes talking to his patients some:
Mind Over Meds. He frames this as combining psychotherapy with psychiatry, as if the therapeutic talking is the main advantage. In fact, his anecdote points to what I, in my personal experience, have felt is the main problem with psychiatric treatment. Many non-severe mental illnesses are vague and nebulous, and I think there are more flavors of things like depression than psychiatrists have acknowledged. The questions one is asked when diagnosing depression -- how often are you depressed, how depressed are you (scale of 1 to 5, please), are you ever depressed for weeks at a time, do you ever have suicidal thoughts -- are hard to answer honestly and accurately. I don't know how to quantify exactly how depressed I was on an hourly basis over the past year. I do know that I feel inconsolably bad sometimes and I want to not feel that way, and I also know the answers to the checklist of questions that will result in the classification of depressed enough to warrant medication but not so depressed as to require hospitalization. I do not know that I want medication, but I do want some treatment, and medication is a treatment and maybe it will work. I don't know how non-me people feel, or would feel in my environment, so how can I tell if my mood is above or below average, and exactly how many standard deviations from average it is? This is a long-winded way of me saying that I think the problem with psychiatry is that (a) we don't know what is going on with the brain and (b) the checklist of questions is a total oversimplification of the diagnosis process. So I agree with the author, the psychiatrist should talk to his patients, in order to diagnose their problems better than a look-up table of answers to ambiguous questions. I've been to therapists as well as psychiatrists, and I've found the advice of therapists rather useless. The whole trying to rethink things does not work, as far as I can tell. I think my problem with it is that this type of therapy is suggesting that I consciously decide to perceive the world or whatever in a different way. I can conceive of other ways to perceive the world all on my own, but I can't perceive things differently. That's some kind of double-think thing they want me to do, and I don't appear to be capable of double-think yet. Perhaps I need a visit to Room 101. Anyways, therapy does not seem to work for me. But, it would have been nice to have a psychiatrist really try to figure out what my symptoms are.
[Image credit: Paleofuture]
