Psychiatrists Providing Psychotherapy?

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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

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

23 COMMENTS

  1. Could there be a hierarchy within providers of mental health care, with psychiatrists calling the shots, maintaining their status and salary grade over those lower down? These at the lower level include psychologists, nurses and social workers who all work at the sharp end but ultimately are seen as lessers, if not by patients but by insurance companies, Pharma Inc. and others who maintain the status quo.

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  5. I live in Scotland, UK, and it makes sense I think for psychiatrists to be skilled in psychotherapy and to be good listeners. We have a national health service so there would be no money for doctors providing talking therapies.

    My son’s psychiatrist since 2012 is a qualified psychotherapist and he worked with us in the tapering of Haloperidol so by August 2012 my son was off the drug and has been drug free since although with a diagnosis of bipolar disorder. However it was my son’s decision to wean himself off the drug and I gave him peer support, having tapered psych drugs myself in the past.

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  6. Perpetual thanks, Phillip, for speaking the truth. “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.” Had I any idea this is what psychologists and psychiatrists were doing, I never would have bothered to seek assistance from them when trying to overcome my denial that my child had been sexually assaulted.

    According to my psychologist’s medical records, she went and got a list of lies and gossip from the people who allegedly raped my child (and at this point, possibly many more), and used these lies to delude my husband into agreeing I need to be medicated. Then she completely deluded the psychiatrist she sent me to.

    In the end, once the medical evidence of the child abuse and these lies had been handed over by some decent but disgusted nurses in my PCP’s office, and I confronted the psychiatrist. He was so embarrassed he’d never bothered to listen to a word I said, that he tried to get my son drugged up, re-medicate me, and ultimately he declared my entire life, my concerns, everyone I’ve ever met, where I’d lived, the universities I’d graduated from all part of a “credible fictional story.”

    Relationship and personal problems are not biological illnesses, how absurd it was to meet people who harbor such insane delusions. But keeping child molesters on the streets, I’m quite certain, is good for psychiatry because it brings in more customers. But it’s not good for society. Six stigmatized and drugged children committed suicide in my ex-therapist’s neighborhood by the time my child graduated from high school, she had the highest suicide rate in the nation in her local school. Coincidence? I doubt it.

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  9. As a child psychiatrist with a background in neuroscience, psychoanalysis, and Ayurveda, I chose to begin a private practice six months following graduation from residency, because of the frustration I have for the system that we have in place. I predominantly provide psychotherapy in my practice and guide people in making wiser choices to help them come off of medications. I find that many psychiatrists are truly frustrated with the position they are placed in. Psychiatric jobs at agencies are, these days, for medication management. Many of my colleagues are also recent graduated with an incredible amount of debt from medical school, growing families, and expenses that can only be managed by taking the agency or university jobs. Please do understand that many of us came to medicine with bright, young eyes and open hearts only to find a world blinded by greed and suffering. We’re all doing our best to fight the good fight in any way we can.

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    • Please share our work for truth and honesty in psychiatry…anything less is unethical…Please don’t trade integrity for income…we need honest psychiatrists…speak the truth and help expose Big Pharma, and trauma, often the real source of pain and struggle in people’s lives, especially children’s lives…don’t push meds, especially on young children…

      Best Wishes and I appreciate how difficult it is to work as a psychiatrist in our current system…This website can be a source of support…

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  10. Dr. Hickey,

    Based on our past correspondence about the bipolar epidemic and Dr. Nassir Ghaemi’s huge contribution to it, I am very pleased about your recent articles on SSRI induced mania now included in the DSM V as justified for a life destroying bogus bipolar stigma for all ages and this one about Dr. Ghaemi’s usual utilitarian approach especially when it comes to his addictive passion to stigmatize everyone on the planet with bipolar as well as the psychotherapy discussed here. To facilitate this goal he is constantly advocating for his version of “evidence based medicine” described by The Last Psychiatrist below with the top priority being to keep the bipolar/Big Pharma gravy train going and expanding exponentially as well as Ghaemi’s role as a supposed “mood disorders” expert. There is little doubt that any so called therapy provided by Ghaemi and his minions would revolve around doling out bipolar stigmas and forcing people to take their lethal drugs depending on what is on patent and making the most billions for the psychiatry/Big Pharma cartel. This is typical of much of what passes for “therapy” today in that it serves to brainwash people to accept their lifelong bipolar or “mental illness,” accept they will live a horrible, disabled life at the mercy of psychiatrist till death do they part (much earlier by about 25 years for the victims due to the toxic drugs) and they can never amount to anything other than being a psychiatric slave for life.

    Here is The Last Psychiatrist about this approach by Ghaemi with bipolar:

    http://thelastpsychiatrist.com/2008/04/experts_weigh_in_on_bipolar_di.html

    http://thelastpsychiatrist.com/2010/01/the_massacre_of_the_unicorns_i.html

    http://thelastpsychiatrist.com/2006/11/massacre_of_the_unicorns.html

    Thank you for your ongoing take no prisoners meticulous, honest, scientific “analysis” of biopsychiatry, contributions to the bipolar epidemic and certain enablers like Nassir Ghaemi that keep this predatory, destructive paradigm going at the cost of countless destroyed human lives.

    Since bipolar disorder is the new “sacred symbol” to justify psychiatry’s existence, I would welcome any future insights you might be willing or able to share about the bogus bipolar epidemic destroying countless lives from in utero to grave.

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  11. It is obvious that problems in living are not solved by modulating brain chemistry with drugs. It is also obvious that they are not solved by sitting in a room and talking and talking (with a psychotherapist).

    Just a simple hypothetical example which is easy to understand. If a giant monster started trampling your city and you were about to die because of it, and you were depressed because of it, do you think gulping antidepressants or talking endlessly to a psychiatrist/psychologist will remove the giant monster and save your life? No. Something would have to be one about the giant monster.

    That being said, there IS a place for drug use. Sometimes they are needed. But it is how, why and to what end they are used that matters.

    Psychotherapy is also useful in some instances. For instance, some people have a fear of dirt or contamination (I personally don’t have this problem, this is just an example). Exposure and response prevention may be useful in a situation like this.

    However, in cases of abuse where one human being causes harm to another, you can’t just keep drugging the abused with pills and keep talking to him/her endlessly and expect problems to vanish. You have to do something about the abuser. This is under the purview of the law and of the police.

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    • “However, in cases of abuse where one human being causes harm to another, you can’t just keep drugging the abused with pills and keep talking to him/her endlessly and expect problems to vanish. You have to do something about the abuser. This is under the purview of the law and of the police.”

      That is an excellent point. It’s astonishing how fast people recover from “incurable life-long mental illnesses” the moment out take them out of abusive environment. I also think adding some prison time for the abusers would speed up this recoveries substantially.

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