11/16/13
Psychiatry has made many important advances over this past century in the treatment and diagnoses of psychiatric disorders. And, I feel that these discoveries will only increase and unfold over time on all levels.
Yet I wonder if the field of Psychiatry has gone to an extreme of sorts.
There is so much focus on symptoms, illness and disease, have we forgotten about psychiatric wellness and prevention?
Psychiatry I feel needs to move to the forefront of wellness and prevention but instead I feel lags behind in its focus and mission.
Other fields like Internal Medicine, Family Practice and overall Primary Care are at least stepping into the paradigm of prevention, wellness and Integrative Medicine and I feel it is important that Psychiatry even take a lead role.
Fifty percent or more visits to Family Medicine and Primary care have their origin in depression, addictions, and anxiety--- and related issues and these issues can be both covert and above board---- disguised behind medical problems.
In our current system, many receive medications but very little else---in primary care--after checklists of symptoms reveal mood and anxiety. Patients are often given medicines that are being shown to be about 50/60 percent effective and that too useful if they do not have side effects that are not often well tolerated for the long haul.
And, by the time patients and clients come to Psychiatry for treatment (if at all), they have often been through many trials and tribulations of various treatments and medications.
Individual and group therapy abounds but the question is whether people are regularly using these services or whether visits are hit and miss, brief or interrupted for a variety of reasons.
In my experience there are many internal and external blocks to regular one one one and group therapy and it is often not clear what the ef fectiveness is with therapy in its present states.
Mainly I have found finances, logistical headaches with insurance coverage, transportation to and from the office, severe anger, resentment and disdain from patients at resultant "NO-Show" fees if they do not come to a scheduled therapy appointment,---in general--- resistance to treatment for various reasons all play a key role.
And, over the years I have found that no one component of anything is enough for one's journey in health and healing.
Psychiatry maintains the need for medication management and therapy as the cornerstone of treatment. There are other modalities but they is not as much focus on other methods in a typical psychiatric practice or treatment setting. But what does "going to therapy"--really mean? A few visits? Lifelong interventions?-- Six months, 7 months and so on? Group interventions in an inpatient setting which are often superficial, outdated and cursory at best, unless much time energy and thought is placed into them by the therapist, institution and so on. Issues then continue to abound things get complex and so the therapist or client sometimes just wind down and say things are better or even sometimes worse? And what is really gained from therapy in these once or twice hourly sessions --or even 4/5 times per week in classical psychoanalysis?
All of these questions are of course up to the individual--as there is no one prescription, method or journey. Progress in therapy, medications and recovery is subjective on all levels but sometimes objective as well.
Psychiatry in my opinion is over-focused on medication management. There are general principles in Psychiatry and a limited range of medicines for various Psych categories that have varying percents of effectiveness. There is no way to predict individual effectiveness despite studies because in Psychiatry no one medication or combination has the identical effect for another based on multiple genetic, personality, and other biological factors. Insurance companies although they have recently changed coding and billing ---still dictate what happens with time and reimbursement in offices that take insurance. And, with ever increasing pressures on Doctors and Nurse Practitioners to see high volumes of patients just to keep their doors open---brief med medication still abounds (15 min. or less) ---and this leaves little room to think and practice "outside of the box...."
While medications discovered and applied in Psychiatry have dramatically helped there are still many loopholes including complicated subtle and overt side effects, long term effectiveness, compliance with treatment, wear off and withdrawal issues to name a few.
And there is a limited armementarium of conventional medications for various problems that are circulated over and over again. In my opinion the poorest options are for sleep and for anxiety---these I feel are the MOST problematic in Psychiatry (except for psychosis)--- and have the least options and the most unclear long term treatment outcomes.
Often people get benefit against a smoldering backdrop of overt and background subtle side effects that they have to bear just to keep functioning---often cognitive slowing and related symptoms, sexual side effects of all kinds and of course dreaded muscle movement problems with anti psychotics that people are at risk for for the long term. Metabolic syndrome with weight gain, obesity, elevated glucose, lipids and other factors are rampant with anti psychotic/anti manic medications and drug companies have spent and earned billions promoting their medications that have these common ongoing risks.
The key in my opinion is that we have to expand consciousness and creativity in Psychiatry.
We have to encourage new models that are funded by patients, grants and private support that foster Psychiatric Wellness.
This means addressing everything conventionally but stepping above and beyond the disease and treatment symptom model. It means managing and raising dollars to create positive self and pre-paid groups to address Self esteem, positive thinking and coaching, lifestyle choices and behaviors, dealing with underlying emotions and issues that fuel current patterns of living-----practice of Yoga and other Spiritual methods of any kind---all to name a few.---all outside the usual loopholes of third party payers ---that often ultimately undermine and block various creative treatment potentials.
In the new model clients and patients have to take financial responsibility to create these centers of Psychiatric well-being and realize that the days of third party payors is archaic and cannot be completely depended upon..
New models with new ideas and deeper interventions and treatments require dollars like anything else and Psychiatry is no exception to this.
The new model needs to be holistic to incorporate the vast storehouse of untapped knowledge and principles of prevention and treatment according to Chinese Medicine, Ayurveda Medicine and Naturopathic Medicine. And, it needs to incorporate treatments that involve the creative arts in the healing process.
We have to completely transform thinking to help clients, and all involved that Psychiatric symptoms and issues are not just a checklist of symptoms and then a squelching of symptoms through medications or a rambling journey through choppy and inconsistent therapy that has many stops and starts---mostly stops in my experience.
There are many clues in integrative and holistic medicine that psychiatric issues are the result of intense difficult lifestyles that involve severe stress and other negative emotions, the direct result of diet and nutritional issues, unresolved trauma and pain, lack of family, social and cultural connections, divorcing from one's creative hobbies and interests, and many other angles including lack of social skills, inability to empathize with others and so on.
The new model needs to have on site abilities and services for people to go to practice various methods of healing for themselves and have a venue of respite through various programs designed for ongoing practice and support in addition to the usual physician and therapy visits. They need to be teaching centers on diet and nutrition and exercise
The new models above all need to focus on strengths, positive abilities, hopes dreams, aspirations and wishes and do anything and everything that focuses on reaching one's highest potential.
Psychiatric illness can then transform into Psychiatric wellness over time.
Dr. Rama
