What Is the New Psychiatry?

I am a practicing psychiatrist and I am proud and committed to my profession. But I think it's time that my colleagues and I smarten up and realize that the field of psychiatry is changing, and that we need to change with it. We have entered an era of the New Psychiatry.

The New Psychiatry means using all tools at our disposal, including medications, therapy, self-help books, yoga, politics, music, and whatever else works. The New Psychiatry is not boxed in by artificial constructs like "professional turf." It is not beholden to any commercial enterprise, such as the pharmaceutical or device industries. It is not hypnotized by the DSM-4 (our diagnostic manual), but sees it for what it is-an elaborate list and a useful field guide, but not a bible.

Maybe you've been lucky enough to see a "New Psychiatrist." These doctors understand how to match psychiatric medications to your symptoms, but also understand their limitations. They are not influenced by pharmaceutical sales reps, and they want to do more than prescribe the hottest new drug on the market. These doctors know the most effective techniques of psychotherapy, and use them when they need to. In short, they customize treatment to match each patient's individual needs.

In 2002 I was a speaker for Wyeth Pharmaceuticals, going around to doctors' offices saying nice things about the antidepressant Effexor XR. One year and $30,000 later, I realized that I was unable to keep the financial incentives from influencing my talks. I had found myself highlighting the good qualities of the drug and dancing around the side effects. Eventually I quit all the speakers' bureaus and some years later wrote about the experience in The New York Times Magazine.

So now, I am an unconflicted psychiatrist-at least in terms of the drug industry. I prescribe whatever I think is best for my patients. Sometimes that is the latest and greatest and most expensive drug. Other times, I use cheap, generic drugs, such as trazodone, one of the finest sleeping pills available, and which is not addictive and costs pennies per dose.

Do I do psychotherapy? Some, but less than I should. During my psychiatry training at Massachusetts General Hospital I took plenty of therapy seminars. But when I started practicing in the mid-90s, the psychiatry crowd was obsessed with psychopharmacology, and its endless process of tinkering with medications, adjusting dosages, and piling on more drugs to treat the side effects of the drugs we started with. The medications often work, but like "Invasion of the Body Snatchers," psychiatry has allowed psychopharmacology to permeate every corner of the profession. In the process, many of us have forgotten what it's like to treat a patient's mind.

Psychiatry has become unhinged from its original mission to help patients recover from mental illness. Instead, we have been seduced by drug companies to believe that medications are the answer. We are transfixed by the idea that we are "real doctors," and therefore superior to psychotherapists who do the menial, messy work of understanding people's lives. And our national organization, the APA, is hemorrhaging money in a losing turf war against psychologists who seek-and in some states have already won-prescription privileges.

In this blog, I will outline new treatments and old problems, explore ways mental health professionals can work together, and discuss how my profession can give up our addiction to pharmaceutical industry cash. Please join me for a wild-but fun-ride.