First and foremost, I want to thank Robert Whitaker for his support of my work, and for offering me the opportunity to blog for MIA. It can be quite scary and lonely to step out and away from your field and begin to share your worries about the direction it has gone (and continues to go). To be welcomed into a community of like-minded individuals who share my concerns about the growing madness in psychiatry and the “mental health” universe, is truly a gift. I feel blessed, honored, and humbled to be able to tell you what I have seen, and learned, over the course of my clinical practice. I welcome the opportunity to share my thoughts, and to hear yours, about what we need to do to heal a field gone mad.
I think it best that I tell you a bit about myself, given that this is my first blog. I need to tell you where I have come from, and why I have chosen to leave.
I am a Board-Certified psychiatrist, with my Diplomate Certification from the American Board of Psychiatry and Neurology. I have been in the field of medicine for 35 years, or for the equivalent of my entire adult life. This has been my passion and pursuit forever. I have never taken a break, or even a substantial period of time off, from clinical practice. I have seen patients for therapy, treatment, and care for 35 years.
Along the way I have also written books about integrative healing, been a radio host for a call-in radio show, a columnist for Massage Therapy Journal, a professor, the Medical Director of at least four facilities, and even a Chief Medical Officer (CMO). I have spoken at conferences and training programs all over the world, and have even been the key note speaker at conferences devoted to integrative healing. I was on faculty at the University Of Arizona School Of Medicine in the Center for Integrative Medicine when living in Arizona. And I have practiced throughout the United States, and even for a year and a half as a Senior Medical Consultant in New Zealand. So, I have seen a lot. And it has been a blessing and a curse.
Part of what I have seen, and what has shaken me to my core, is the way the role of psychiatry has changed over time. We psychiatrists are no longer healers, therapists, doctors, and partners in healing. We are now “medication managers.” We don’t treat people, we manage medicines! Today, psychiatrists are meant to see increasing numbers of patients for “assessment” and “standard medication management” sessions. Almost every job posted for a psychiatrist, nationwide, uses the language I have just put in quotations. And I get about ten requests a day to take another one of those jobs.
Let me give you some numbers to put this new world of psychiatry into perspective. I can’t quite believe what I am about to share with you. But my organization (that I will be leaving as of March 4th) keeps track of these numbers, so I am sure they are correct! Here is the data:
In just the last two and a half years, I have seen 1,131 new patients for diagnosis and treatment recommendations, and have seen my active patients for a total of 5,428 follow-up visits. The numbers are staggering to me, given that they represent 6,559 one-on-one encounters with people in pain. To walk the path I have been honored to walk with those in need of help, guidance, and support is a great honor and responsibility.But think about those numbers for a moment. How can I, or any psychiatrist, get to know a person, sort best options for them, and chart a course for healing when the medical model drives patients in and out of the office every few minutes?
Today, I am able to spend less time with a patient in their routine office visit than I used to spend talking to a potential patient on the phone before I ever met them in person for an appointment! Back then (10 or more years ago), I knew more about my patients after one visit than I have the opportunity to learn about the patients I have been seeing regularly for the last three years!
This model cannot be good for any of us. I have been trying to change it from within for a long time. And I have not been successful. I have also been learning more and more about the lies we have all been told about diagnostic validity, medication benefits, and the risks of psychotropic drugs. I am grateful to all those who have been challenging the paradigm and bringing the truth to light. It parallels what I have seen clinically for a long time. More and more, I fear we are making people ill, instead of helping them.
I am seeing more patients, on more medications, from earlier on and for many more years, than I have ever before seen in my professional career. And the people I see seem to be getting sicker and not better. Diagnostic spread and the increasing numbers of medications considered standard of care for all these diagnoses is creating an epidemic of medication seekers. People have been convinced that they need meds and more meds, so they are searching for someone to continue the treatment. The number of people clamoring to find a psychiatrist for medication management, and being unable to find one, has escalated beyond the stratosphere.
The numbers of job openings for psychiatrists have also grown exponentially since I began to practice medicine. There are not enough people to fill these positions, which all involve doing the same type of work: brief visits for initial assessment (often as short as 30 minutes), with 15 minute followup visits for medication management.
For my first 20 years in practice, roughly a third of my patients were on one medication (rarely, two) for some period of time, and the rest were on none. But now? Many patients come into a first visit already on two or three medications. You have no history with them, no idea how they got on all these pills, whether any of them are working and what else they might have tried, or even the names of the people they have seen for medication before. The patients are rarely in therapy, and your job does not allow you to do it — social workers are supposed to do that.
The whole universe of “mental health” has gone mad. So, after 35 years in medicine, and three years with the same large health care organization where I am now the Medical Director of Integrative Services, I have decided I must quit. I am not willing to be a part of any machine where I doubt in the benefit of what I am being asked to do, and fear it might even be making people sick.
I have been told by many that I need to share my experience in psychiatry. One of my colleagues and friends, Andrew Weil, MD — the founder of the Integrative Medicine Program where I once taught — was especially encouraging. He told me that what I was telling him about my experiences in psychiatry was nothing he had heard before, and he felt my perspective and story needed to be shared. As soon as he said that, I realized I had to do that, and be part of some sort of battle cry and solution. So, I decided to write another book. It concerns the toxic shift I have seen in my field over 3 ½ decades, and what we need to do to stop the train, and start the healing process instead. I was very fortunate to come to know Bob Whitaker as a result of that decision. He was kind enough to read the first few chapters of the book draft, and offer me the opportunity to blog on MIA.
So, here I am. I cannot begin to convey the gratitude I have to all the brave souls who have unearthed and shared things we all need to know, in spite of great challenge to themselves and their careers. I am glad to have colleagues similarly invested in trying to do the right thing. It is incredibly powerful to be supported in taking an unpopular position. Challenging the status quo, especially when there are huge dollars, organizations, and individuals invested in perpetuating and growing the system as it is, can be a very lonely endeavor. I am grateful to be part of this community, and look forward to working with you all to make our world a healthier, saner place.
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.