Aliens Invade Psychiatrist, He Eats Patients!

Reflections on the New York Time's article "Talk Doesn't Pay, So Psychiatry Turns instead to Drug Therapy"

What do journalists want? When responding to a reporter's leading inquiries, I have scrambled to answer this often elusive question. Where is she going with this? A writer I know quipped that poets are people who stand out in the rain and hope to get struck by lightening. If so, journalists, not unlike like historians, show up after the storm and piece through the cinders, scavenging for shreds of information that might fit into a narrative arc. They need and want and must have a story.

This narrative compulsion has been on my mind since I was asked to blog for Psychology Today. For other reasons, the same question recently has troubled many of my colleagues. A front page article by Gardiner Harris appeared on March 6th in The New York Times, entitled "Talk Doesn't Pay So Psychiatry Turns Instead to Drug Therapy." The article profiled one Dr. Donald Levin of Doylestown, Pennsylvania, who claimed that insurance reimbursements radically changed his practice and forced him to eliminate... well, quite a lot. His practice boasted a staggering roster of 1200 patients; the good doctor admitted he barely knew any of his clients' names. Instead, every fifteen minutes, he kept them coming in and out of his assembly-line. Though not proud of this model, he apparently told Harris that he can not and will not slow down if the human before him brings up matters like drinking too much or a pending divorce. Take it to your therapist, he told them, though it was not clear how many even had one. His job? No longer to plumb inner lives, help the afflicted understand their woes or adapt to adversity, provide emotional support, or even tie together complex conditions like marital discord, substance abuse and depression. Rather, all day long, he authored thousands of prescriptions, three-lined pharmaceutical haikus. Like the worst, close-minded journalist who chops up a quotation to fit his story, Dr. Levin jammed his patients into the Procrustian beds of his prescription pad and the dictates of cheapskate insurance providers.

Needless to say this portrait caused a great deal of consternation among my tribe. Our medications are not so potent and specific that they can simply be doled out in such a manner, and the illnesses affecting our patients are not so summarily labeled. However, the question that vexed the most was why The Times deemed this front page material? Where was the news? After all, terrible insurance for mental health care has been a curse forever, and if anything it is about to get better with the success of mental health parity legislation. And a shift to psychopharmacology from psychotherapy has been a very visible trend in psychiatry for at least twenty years. However, this extreme portrait seemed like news to some precisely because of its extremity. The drama provided was the triumph of one cliché over another: the stereotypical psychoanalyst with his couch now had been supplanted by a cartoon-like pill-pusher. Neither cliché is novel; it would have been easy for The Times to profile a fairly similar Dr. Donald Levin in 1960, 1980, or 2000. And yet, Harris insists - as required by his story - that this portrayal represents psychiatry now. A not very exciting counter-example right down the block, Dr. Louisa Lance, who sounds like she practices the standard mix of psychotherapy and medication, is stuck in the "old style of psychiatry." Hyperbole and B-movie caricatures keep driving his narrative: psychotherapy has been proven effective for depression, he tells us, but later dismisses it as just for the "worried wealthy." And long ago, we are told, psychiatrists were "stuck in asylums treating confined patients covered in filth." Really? All of them were covered in filth? Where are those fact checkers when you need them?

The evening after the story ran, I attended a meeting of the New York Psychiatric Society and the room was filled with indignation. A number of colleagues had been interviewed by Gardiner and they expressed shock. He told one female psychiatrist who regularly treated patients with psychotherapy and medication that he wanted to pen a father-son story that highlighted a generational change in psychiatry. Obviously that disqualified her. Then he went on to an eminent psychoanalyst with a daughter who was expert in psychopharmacology. Unfortunately, she herself also did psychotherapy, while her father was a vocal proponent of neuroscience and medications. Lousy story. In the end, the journalist somehow happened upon Dr. Levin, and the stunning nature of his practice overwhelmed the generational narrative so that Levin's son, a psychiatrist in training, entered the piece as merely a grace note. The story of a mind-doctor machine and his dehumanized clientele had more appeal than a tale of fathers and sons. Maybe someday, it will be a movie.