Sometimes I’m afraid that the U.S. is becoming a nation of people who expect things to come easily to them. I’m doubly afraid that some professionals charged with helping to help ourselves often take the easy road. What “easy road?” Why, the medication one of course.

Of course, these are easy generalizations to make. But based upon the conversations we’ve had over the past five years with dozens of people seeking mental health treatment, and a myriad of mental health of professionals, we’ve been seeing a common treatment pattern for mental disorders.

The Problem of Treatment

Mental disorders are not, despite the propaganda pushed by others with an agenda, simple things. They are not, for example, simply a “brain disease” or some other kind of medical disease that has clear precursors and laboratory tests to match. While research is ongoing, we still don’t know what causes major mental disorders like depression, bipolar disorder, ADHD or schizophrenia. All we know is that there are specific psychological, social and biological components to mental disorders, and any treatment that focuses on one of these areas to the detriment of others is likely going to limit how quickly the person starts feeling better, and how much better they can feel.

When mental disorders are treated exclusively with one treatment modality – like medications, psychotherapy, group therapy, self-help groups or books, etc. – the person isn’t going to feel as better, as quickly. In fact, as research over the past few years has shown, some treatment options may have little beneficial effect.

The answer? The answer is surprisingly simple and well-accepted by most mental health professionals – people need a combined, holistic approach to their treatment. Except for chronic conditions that last for years, most people will benefit from a combined treatment approach that offers medication, psychotherapy, and even a self-help aspect (like an online support group or reading). Research time and time again shows that treatment methods that offer such a combined approach result in better patient outcomes which usually also occur more quickly than any single approach on its own.

Psychotherapy? No Way

Yes, therapists want to see more people in therapy. But most people are scared to death of the idea of therapy. They don’t want anyone prying into their carefully constructed lives and lies they tell themselves to get through each day. We are a delicate balance of what works and what isn’t working, and most of us manage to keep this balance fairly in check. The idea of psychotherapy is just plain scary. And the skeptical among us wonder how much can simply talking about our lives and our problems really result in our feeling better.

Psychotherapy only works when one is ready to accept changes in one’s life. That’s one of the reasons it’s so scary (beyond the fact that it is one of those mysterious, unknown relationships that until one tries, it seems as strange as a three-eyed person). To feel better often means we have to change aspects of ourselves, our lives, things we know, trust, and feel comfortable with. Changing those things can be beyond challenging – it can be downright unthinkable. Why engage in a relationship that asks us to do the unthinkable?

Medications Are the Answer!

Well, yes, they are a part of the answer, but in no way are they the whole answer for most people. For serious mental disorders – like depression, anxiety, ADHD, bipolar disorder, schizophrenia, etc. – medications are almost always recommended. They help alleviate symptoms usually more immediately (although many antidepressants can take 6 to 8 weeks before their full effect is felt), and reassure a person that there is medicine (e.g., “science”) that is helping us. Because to most Americans, science comes in encapsulated pills, not in knowledge itself.

Some people believe we are overmedicated, we rely too much on medications for all of the answers. In general, I’d have to agree. There are far too many people who believe that medications do offer all the answers, and don’t even consider additions to medications to help with their treatment (what professional might call “adjunctive treatment”).

The problem is hurt, not helped, by physicians who are often all too willing to be complicit in the oversimplification of mental disorders. They write the script for the medications they know, make the cursory referral to a mental health professional, but don’t do much more than that. They don’t insist. They rarely educate patients about the complexities involved in mental disorders, that a prescription alone is unlikely to cure their ills. And followup varies widely from doctor to doctor.

It’s not clear whether this behavior is as a result of the general practitioner’s training, experience, harried schedule, or desire to try something out they know their patient will go along with, with the least amount of resistance or argument. I’ll give most physicians the benefit of the doubt and say it’s often a combination of all of the above. But just as a family doctor wouldn’t dream of conducting surgery on their patients, I’m not sure why they feel comfortable in believing they can simply prescribe a psychiatric medication and hope the patient will feel better in time.

Family physicians are the first-line, front-line professional most people go to for mental health issues. I have no doubt most are excellent screeners for most general mental disorders. But that should be the extent of their role, in most cases, for most people’s mental disorders. Treatment should nearly always be handed offer to a team of mental health professionals for care and followup.

The Combined Approach

The default conversation has to change. People need to stop expecting quick fixes for serious, complex issues in their lives. Depression isn’t like a virus that strikes a person out of nowhere. Bipolar disorder isn’t simply passed down from generation to generation. Schizophrenia isn’t simply about taking your medication every day.

Professionals and researchers need to stop promising or suggesting that such quick fixes are available as well. There is no treatment on this earth – medication, psychotherapy, self-help approach – that will offer instant relief or a cure. There just isn’t. It’s a lengthy, involved process, and it’s going to take time. It’s going to take effort. It’s going to take change. And, at the end of the day, even all of that may not be enough.

Because we’re still in the early years of fully understanding mental disorders. I like to say we are today where physicians were a hundred years ago in understanding how the heart works. We may very well have another century before the brain and these disorders – and effective treatments – are fully realized.

    Last reviewed: By John M. Grohol, Psy.D. on 1 Oct 2007
    Published on PsychCentral.com. All rights reserved.