On December 29, Nassir Ghaemi, MD, a psychiatrist and a professor at Tufts Medical Center, published on Medscape an article titled Psychiatry Prospects for 2015: Out With the Old, In With the New?
The article opens:
“With the new year reviving old desires, one may wonder what, if anything, new will be in store for the practice of psychiatry. Will there be anything practice-changing?”
Under the heading “Toward More Effective Psychotherapy”, Dr. Ghaemi states:
“Besides medications, an important change for practice is happening that involves psychotherapies.”
Dr. Ghaemi explains that, because of the Mental Health Parity Act and the Affordable Care Act, insurance companies are no longer “…allowed to limit the number of psychotherapy visits.”
“Now, psychotherapies are better reimbursed, longer-term.”
All of which sounds fine. But watch where he goes with it:
“This is a major benefit for psychiatric practice. Clinicians can stop pretending that relationship and social problems have to be shoved into a biological-sounding DSM category (such as major depressive disorder or generalized anxiety disorder) and treated with the only thing insurance companies would reimburse long-term: drugs.”
So there it is, starkly stated: Clinicians, by which he clearly means psychiatrists, have been pretending, (a euphemism for lying), that relationship and personal problems are biological illnesses. And they can stop pretending that these kinds of problems can be treated with drugs.
Note the word “can.” Psychiatrists can stop lying to their clients, and can stop pushing drugs on them. There is a clear implication here that prior to the MHP and ACA, psychiatrists’ hands were somehow tied in regard to these activities – that they had to lie and had to push drugs – that they had no choice.
But in fact, the only thing that’s changed is that they can now get more money from insurance companies for providing psychotherapy. They can now stop practicing deception and drug-pushing, because there is another source of revenue. What a relief – to be rescued from the pit of venality by the government-mandated largesse of insurance companies!
The fact is, there never was any compulsion for psychiatrists to practice deception and drug-pushing. Rather, they chose these activities, and ardently embraced the drug-pushing culture because it suited their purposes. Dr. Ghaemi’s assertion that they can now embrace psychotherapy because the money will be better strikes me as cynical to the point of crassness, and underlines what I’ve frequently written: psychiatry is intellectually and morally bankrupt.
The fact that Dr. Ghaemi doesn’t even appear to recognize the enormity of his admission speaks volumes.
And besides, where in the world – or at least where in the US – would one find psychiatrists who have had either the training, experience, or interest in psychotherapy? Robert Berezin, MD, a Harvard psychiatrist with thirty years’ experience, has written: “In many [psychiatric] residencies, psychotherapy is not even being taught.”
Indeed, the notion that one can switch from a practice of deception and drug-pushing to psychotherapy betrays a massive failure to grasp what psychotherapy is all about.
In August 2013, Dr. Ghaemi wrote the following on his blog Free Associations on Medscape:
“Psychosocial life events can influence the timing of a depressive episode, but if someone has repeated depression, biology is the underlying cause of the predisposition to those episodes. That’s why 10% have episodes with the same life event that doesn’t cause episodes in 90%.” [Emphasis added]
Setting aside the faulty logic of this assertion, should we now, in the light of his current article, conclude that he was just pretending?
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This blog is also on Philip Hickey’s website,
Behaviorism and Mental Health