PSYCHOTHERAPY AND DRUGS

Victor Bloom MD

Grosse Pointe Park

Psychiatrist and Psychoanalyst

In conducting a conference on psychotherapy of psychiatrists in training, I mentioned the case of a young woman who was very depressed and relatively unresponsive to psychotherapy and anti-depressive medication. She was marginally functional but preferred to 'escape' by sleeping and watching 'no-brainer' TV for hours on end. She was stuck in a love relationship that was going nowhere and a job that was also leading nowhere. Her life was passing her by and she was ruminating on how awful her boss was and how wonderful her lover-friend was.

The minute the young psychiatrists heard anything sounding like repetititive thoughts, they came up with the name of the latest anti-depressive medication and had samples available. It seemed to be nothing more than a knee-jerk response to a symptom, and they have been seemingly brainwashed by the drug industry to respond with a drug instead of understanding. The drug industry has succeeded in capturing psychiatric heads of departments and researchers, now that federal funds have dried up, and experienced teachers of psychotherapy have an uphill battle to convince young psychiatrists that patience and persistence in exploring the unconscious and developmental roots of mental disorders is often most helpful in the long run.

My own experience is that many patients have been treated symptomatically with supportive (as opposed to 'exploratory') psychotherapy and medications (tranquilizers and anti-depressives) for years and their clinical condition often does not only does not improve, but it deteriorates. That is a signal that the underlying conflicts have not been brought to the surface and resolved through talk-therapy. I have had patients that had been chronically suicidal for years and given up as hopeless, but after intensive psychotherapy (two or more full sessions a week) there would be great improvement.

The new breed of psychiatrists are 'expert' in finding the right drug for the right person, and it is true that thorazine emptied the state hospitals and prozac is the current 'miracle-drug'. When it works, there is no questioning the result, but often a drug alone does not work, and multiple 'shot-gun' drug therapy is a signal of impending failure. On the other hand, many of the severely disturbed are now on the streets and in the jails, and our society cannot be proud of that fact. The fact is, there is no substitute for an understanding and ongoing human relationship, and competent psychotherapy is just that.

Even though many people have been warned to stay away from psychiatrists and exhorted to be strong and take care of their own problems, psychotherapy has been useful in helping troubled individuals for almost a century now, and also for couples and families. The psychotherapy of children and teenagers has prevented many a suicide and ameliorated many serious emotional problems. Although it is difficult for the consumer to find the right person, the advice of friends and physicians is often helpful, and one does not have to look far, nowadays, to find a person who has benefitted from psychotherapy and would offer good advice. A little comparsion shopping is in order. University and public clinics are available for those who are in financial difficulty, so no one should be without professional help for emotional disorders.