A recent survey paper published in the August issue of the Archives of General Psychiatry shows a marked decline in office visits for psychotherapy, as well as a significant decline in psychotherapeutic services provided by psychiatrists. The proliferation of psychoactive medications for lesser mood dysfunction has been immensely helpful as a therapeutic intervention, but is the quick fix an obstacle to true healing?
The numbers published in this survey review show that in a nine year period, between 1996 and 2005, office visits for psychotherapy declined from 44 to 29 percent (N=14,108). In addition, the National Ambulatory Medical Care Survey, from which the data was culled, shows a decline in psychotherapeutic services provided by psychiatrists from 19 to 11 percent.
The data suggest that, as the administration of medication has become more common in treating lesser mood dysfunction, there has been a shift away from reliance on the traditional transactional therapeutic process as a co-occurring intervention. Where, in these lesser situations, medication is intended as an aid to deflecting symptoms so as to get at the root issue, it would also appear, given this apparent trend, that simply alleviating those symptoms has become enough. Teach a man to fish...
There is little doubt that medication is effective in the treatment of disorders of profound organic dysregulation, such as Bi-polar depression and Schizophrenia. The data presented here gives rise, however, to the speculation that there is a trend toward an over-reliance on medication as a solution to issues that are more psychosocial in nature.
This is not wholly the fault of the professional community, but is more likely an artifact of a culture has become fixated on instant gratification and, in service of that, is fast becoming a bastion of a Band-Aid mentality when it comes to everything from credit to emotional crisis. Personally, I can't count the number of times perfectly healthy clients have walked into my office and said, "I think I need medication.", just because they've had a bad week.
Psychology, at its core, is about introspection and understanding the interior landscape. Indeed, the word psychology derives from the Latin roots psyche, or spirit, and logos, or knowledge, intending a "knowledge of the spirit", where spirit refers to the Self, the authentic "I". We have, in a world of quick fixes and instant relief, apparently moved away from this intention and closer to a state of ignorance.
Ignorance here is used in two ways: ignorance in the spiritual sense of "not knowing", and ignore-ance in the true, active sense of not paying attention, or not being present. The use of medication as an endgame solution to situational emotional distress has, in some respects, shackled our redress of the deeper questions of the human condition with which we may be confronted at any given time, both as professionals and as those seeking relief from and understanding of that emotional distress.
There is no easy answer here - only commentary, and more questions. More meds, less therapy; does that mean we are over-diagnosing? Are we over-prescribing? Are we getting sicker? Are we getting lazy? Are we, in the end, getting anything?
Buddha said, "All things in moderation...including moderation." It would appear that a balance needs to be struck between the administration of medication, the provision of therapy and the expectations of clients seeking relief and understanding. A little more diagnostic circumspection on the part of professionals, as well as a little less entitlement on the part of patients, might well be in order all around.
© 2009 Michael J. Formica, All Rights Reserved
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