I recently finished reading Unhinged by David Carlat. All in all, it was a thought provoking book that is worth reading for anyone who is trying to navigate their own mental health.
One of Carlat's main points is that we have thrown therapy out the window and replaced it almost entirely with psychopharmacology. This isn't a good thing, Carlat argues, because psychiatrists miss what's really going on, why a patient is coming in for treatment then, and how the patients thoughts and behaviors are causing or exacerbating their current difficulties. Psychiatrists medicate and move on.
This is an argument I encounter a lot both in my reading and in my personal interactions. When I told a friend of my I was going to see a therapist she said, "That's good. Medications don't treat the underlying cause. They're just a bandaid. Therapy gets at the underlying causes of what's going on."
I do agree that medications don't treat the underlying cause. Whatever they do is complicated and contentious. However, in all this therapy hoopla, no one really seems to get at what therapy does. There's a good deal of evidence that therapy does help at least some people and research shows that it is often times more effective than psychiatric drugs. But therapy can also harm some people. And so much depends on what type of therapy we are talking about, what the patients issues are, how good the therapist is, whether patient and therapist are a good match, etc. It just strikes me as irresponsible for Carlat to advocate so strongly for more therapy without really exploring what its limitations might be. Admittedly, the book would be deeply discouraging if it just said psychopharmacology is a limited approach and didn't present an alternative.
I say all this for deeply personal reasons. I went to a therapist (a psychologist who practiced CBT, came highly recommended) a few months ago who just didn't seem to get OCD. It was really frustrating and a suffered more than I would've otherwise under her misguided advice. I'm happy to have not gone the medication route, but the therapy route hasn't been an easy one either.
One of Carlat's main points is that we have thrown therapy out the window and replaced it almost entirely with psychopharmacology. This isn't a good thing, Carlat argues, because psychiatrists miss what's really going on, why a patient is coming in for treatment then, and how the patients thoughts and behaviors are causing or exacerbating their current difficulties. Psychiatrists medicate and move on.
This is an argument I encounter a lot both in my reading and in my personal interactions. When I told a friend of my I was going to see a therapist she said, "That's good. Medications don't treat the underlying cause. They're just a bandaid. Therapy gets at the underlying causes of what's going on."
I do agree that medications don't treat the underlying cause. Whatever they do is complicated and contentious. However, in all this therapy hoopla, no one really seems to get at what therapy does. There's a good deal of evidence that therapy does help at least some people and research shows that it is often times more effective than psychiatric drugs. But therapy can also harm some people. And so much depends on what type of therapy we are talking about, what the patients issues are, how good the therapist is, whether patient and therapist are a good match, etc. It just strikes me as irresponsible for Carlat to advocate so strongly for more therapy without really exploring what its limitations might be. Admittedly, the book would be deeply discouraging if it just said psychopharmacology is a limited approach and didn't present an alternative.
I say all this for deeply personal reasons. I went to a therapist (a psychologist who practiced CBT, came highly recommended) a few months ago who just didn't seem to get OCD. It was really frustrating and a suffered more than I would've otherwise under her misguided advice. I'm happy to have not gone the medication route, but the therapy route hasn't been an easy one either.
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