Psychiatry: What Has Happened To You?

What has happened to psychiatry?  It used to be psychiatrists were the experts on therapy and medication.  But these days, psychiatrists are diagnosticians and medication managers only.  I am not sure how the change occurred or why.  Therapy  now occurs in the capable hands of PHD psychologists or licensed social workers.

My brother, who has schizophrenia, was saved by a psychiatrist.  His psychiatrist provided support, therapy and medication management.  He was available  for my brother at his worst times.  He helped him get into a training program and secure a job with a business that hired the mentally ill.  He never let my brother down.  When Clozaril came on the market he got my brother on it.  My brother became stable and was an example of how a certain type of psychiatric approach and care could make a difference.

I just don’t see this approach anymore.  Psychiatrist give patients 30 minutes for an initial visit and after that 15 minutes to review medications.  Does the training no longer include therapy? Is making the diagnosis the crux of psychiatry these days?   There doesn’t seem to be the personal involvement, interest in the person or oversight anymore.  My thinking is who better to talk to the patient about their illness than the person who made the diagnosis.

When my brother’s psychiatrist died, he struggled to find stability and not become too anxious.  He had difficulty finding someone who would do talk therapy.  He wanted a psychiatrist not a counselor.  He didn’t understand why he would need or want anyone else than a psychiatrist.  I tried to explain the change.  He shrugged his shoulders and said he would just continue to get his medications.  It seems every time he finds someone, the person leaves the clinic in a few months.  I think he has lost interest in pursuing talk therapy.

I am saddened by the shift in this specialty.  I have had to change how I think about psychiatry and what services it provides.  My clients complain to me that their psychiatrists only want to know how they feel in order to manage their medications.  What can I say?

What has happened to psychiatry?