Ever since grad school, I’ve always bristled at the arbitrary battle lines drawn between the various professions who treat mental disorders. Psychiatrists battle with psychologists, psychologists battle with clinical social workers, and so on. These turf battles do little to help people in need, who only want the best possible care available.
But don’t tell that to the evangelists within the respective fields. I actually get embarrassed when I hear psychologists talk in semi-private groups about how they need to get the word about their “superior” abilities to treat mental illness. Research simply hasn’t borne out this attitude. Until it does, I have always looked at the value that each profession brings to the field and respect each for what they bring.
So it’s with this background that I read and appreciated Dr. Danny Carlat’s recent take on the antidepressant study that came out demonstrating two antidepressant’s lack of effectiveness for most kinds of depression. He had some criticisms of the study, which are fine.
But his entry today calling for an end to the artificial dualism struck a particular cord. It’s never either antidepressants or psychotherapy. It’s sometimes one, it’s sometimes the other, and it’s sometimes both (and I’m a firm believer that it should almost always be both).
So my question is, why don’t we embrace all these potential cures rather than lining up behind our favorite technique to defend its merits? Drugs work. Therapy works. Time works. And placebos work. If psychiatrists and psychologists could possibly call a truce in their various battles over therapy effectiveness and prescription privileges, we might be able to imagine a different kind of practitioner — one who is skilled in both psychopharmacology and psychotherapy. Isn’t this the kind of doctor we would all want to see when it’s our turn to get help?
We don’t need this ongoing proselytizing in the blogosphere that’s shared by many academics, researchers and evangelists in their respective professions. It reminds me of a religious debate, where issues are painted in black and white terms — when we all know the world is comprised of so many wondrous colors and shades of gray. Are SSRI antidepressants sometimes overprescribed and used for their placebo well-being powers as much for their antidepressant properties? Absolutely. But is that a reason to demonize all antidepressant drugs or psychiatric drug prescriptions? Absolutely not.
The problem that remains, however, is who is this ideal practitioner Dr. Carlat refers to? He suggests it’s a psychiatrist who is simply trained different. But it could just as well be a psychologist, who is also trained differently. As long as the door is open to both psychiatrists and psychologists, then I’m on board to ending the artificial dualism, this false dichotomy. All professions have something to offer the field, and to those in need of mental help. It’s time to put aside our professional differences, and reach across the aisle to ensure that individuals in need get the best possible care, no matter what it may be.
Read Dr. Carlat’s full entry: Antidepressant Effectiveness and False Dualism: It’s Time for a New Psychiatry