June 29, 2010: Unhinged: The Trouble with Psychiatry

>> Emily: MEDICAID THE SYMPTOMS

WITHOUT ADDRESSING THE ILLNESS.

THAT'S WHAT NEWBERRY PORT

PSYCHIATRIST DR. DANIEL CARLAT

SAYS HAPPENS WHEN DEALING WITH

MENTAL PROBLEMS.

HE ADDRESSES THE ISSUE IN HIS

NEW PACK "UNHINGED, THE TROUBLE

WITH PSYCHIATRY, A DOCTOR'S

REVOLUTIONS ABOUT A CRISIS".

YOUR HONESTY AND OPENNESS ON

THIS ISSUE WAS SO REFRESHING.

IT SORT OF IS WHAT EVERYBODY

IMAGINES HAPPENS.

HERE YOU SORT OF REAFFIRM THAT'S

WHAT HAPPENS.

>> RIGHT.

>> Emily: I HAVE TO SAY I WAS A

LITTLE -- YOU SORT OF HAD AN

EPIPHANY WHEN YOU WERE SEEING A

LAST BATCH OF PATIENTS INCLUDING

ONE GAL WHOSE FATHER WAS KILLED

IN A CAR ACCIDENT AND PEOPLE

HAVE PROBLEMS WITH MENTAL ISSUES

AND YOU'RE GIVING THEM DRUGS

WITHOUT LISTENING TO THEM.

YOU SAY, HEY, YOU DON'T REALLY

HAVE TIME TO HAVE THE CHAT PART

OF THIS.

>> I THINK THAT'S -- I THINK

MOST PEOPLE WHEN THEY THINK

ABOUT SEEING A PSYCHIATRIST,

THEY THINK THAT PERSON IS GOING

TO HAVE A PSYCHOLOGICAL

CURIOSITY, THEY'RE GOING TO

SPEND TIME UNDERSTANDING WHAT

MAKES YOU TICK.

BUT I FOUND OVER MY CAREER AND

SINCE I GRADUATED FROM RESIDENCY

IN '95 INCREASINGLY I FOUND

MYSELF TRYING TO DO KIND OF A

CHECKLIST APPROACH TO DIAGNOSIS.

SO THE WOMAN CAROL THAT I TALKED

ABOUT, I WAS DOING THIS KIND OF

CHECKLIST THING WHERE I LISTENED

TO HER ISSUES AND SHE WAS IN A

LOT OF PAIN AND SHE HAD

POST-TRAUMATIC STRESS DISORDER

WHICH IS A DSM DIAGNOSIS, THE

DSM IS OUR LIST OF DIAGNOSES.

I GAVE HER A PRESCRIPTION FOR

MEDICATION AND I SAID, I'D LIKE

YOU TO SEE A THERAPIST TOO.

AND SHE LOOKED AT ME, AND SAID,

I THOUGHT YOU'D BE MY THERAPIST.

THIS DOESN'T REALLY MAKE SENSE,

WHY ARE WE FRAGMENTING AND

SPLITTING UP MENTAL HEALTH?

>> Emily: WHY COULDN'T YOU BE

BOTH?

>> PARDON ME?

>> Emily: WHY COULDN'T YOU BE

BOTH?

AREN'T THERE CERTAIN

CIRCUMSTANCES WHERE YOU SEE

CAROL THREE OR FOUR TIMES AND IF

IT WASN'T IMPROVING, AND YOU

FELT YOU NEEDED TO MOVE HER INTO

MEDICATION WAS THAT THE

APPROACH?

>> THE QUESTION IS WHY DON'T

MORE PSYCHIATRISTS DO MORE

MEDICATION AND PSYCHOTHERAPY?

WHAT HAPPENS WITH ME, I BECAME A

PSYCHO PHARMACOLOGIST WHICH

MEANS A DOCTOR WHO SPECIALIZES

IN PRESCRIBING MEDICATION.

AND THERE ARE MANY REASONS FOR

THAT, BUT ONE OF THEM IS THAT

THE INSURANCE COMPANIES

REIMBURSE US MORE HIGHLY FOR

THOSE SHORT VISITS WHERE WE CAN

FIT THREE PATIENTS INTO AN HOUR.

SO THAT WE GET PAID LESS WHEN WE

DO THERAPY.

BUT ALSO WHEN WE GO TO MEDICAL

SCHOOL IN ORDER TO BECOME

PSYCHIATRISTS WE ARE

INCORPORATED INTO THE BIOMEDICAL

MODEL SO WE TEND TO SEE THE

PATIENTS IN TERMS OF DO THEY

HAVE A BIOMEDICAL DISEASE AND IF

THEY DO, THEN WE THINK ABOUT A

MEDICATION.

AND IT'S NOT -- IT'S NOT JUST

ME.

THIS HAS BEEN A TREND, YOU KNOW,

THAT --

>> Emily: AND PLUS, PEOPLE ARE

IN PAIN AND LOOKING FOR RELIEF

AND YOU FEEL LIKE YOU CAN OFFER

IT U.

>> YOU KNOW, IT'S ALSO A

CONSUMER-DRIVEN THING PARTLY.

>> SURE.

>> Emily: THE WORD ZOLOFT ROLLS

OFF OF PEOPLE'S TONGUES.

>> PEOPLE WANT RELIEF QUICKLY

AND IF THEY CAN GET A PILL, A

MEDICATION THEY CAN TAKE EVERY

MORNING AND AVOID GOING TO SEE A

THERAPIST AND POURING OUT THEIR

SOUL, OFTEN THEY WILL CHOOSE

THAT.

YOU KNOW, THE MEDICATIONS DO

WORK VERY WELL.

I MAKE THAT CLEAR IN THE BOOK.

I PRESCRIBE THEM ALL THE TIME,

BUT THEY ONLY REACH A CERTAIN

POINT WITH THE MAJORITY OF

PATIENTS.

AND THEN THE QUESTION BECOMES,

DO WE THEN REFER OUR PATIENT TO

A THERAPIST HOPING THAT THEY'RE

GOING TO GET THE RIGHT KIND OF

TREATMENT, OR DO WE GET THE

EXTRA TRAINING THAT WE SHOULD

HAVE GOTTEN ALL ALONG SO WE CAN

COMBINE MEDICATION WITH

PSYCHOTHERAPY AND REALLY BECOME

WHAT I CALL AN INTEGRATIVE

THERAPY.

>> Emily: AND YOU GOT INTO HOW

YOUR MOTHER COMMITTED SUICIDE

WHEN YOU WERE 20 YEARS AND THE

DEVASTATING PAIN THAT THAT

INFLICTS ON A FAMILY.

YOU WANTED TO UNDERSTAND THE

MIND, PARTICULARLY THE DEPRESSED

MIND, BUT THEN YOU TALK ABOUT

HOW YOU'RE NOT SURE WHAT IT IS

THAT THESE DRUGS DO TO THE

DEPRESSED MIND.

>> WELL, WHAT WE KNOW ABOUT THE

DRUGS AND THESE DRUGS LIKE

ZOLOFT, THEY'RE SSRI'S, THEY

APPEAR TO INCREASE THE AMOUNT OF

SEROTONIN IN THE AMOUNT OF THE

BRAIN.

>> Emily: WHAT IS THAT?

>> THAT'S A NEUROTRANSMITTER OR

BRAIN TRANSMITTER WHICH HELPS

THE NEURONS TO COMMUNICATE WITH

ONE OTHER.

THERE ARE SEVERAL OTHER

NEUROTRANSMITTERS, BUT WE DON'T

KNOW HOW THE MENTAL ILLNESSES

ARE ACTUALLY GENERATED BIO

CHEMICALLY.

JUST BECAUSE THAT IT INCREASES

THE LEVEL, THAT DOESN'T MEAN

THAT IT'S CAUSED BY A CHEMICAL

IMBALANCE WHICH IS ACTUALLY, OF

COURSE, WHAT THE DRUG COMPANIES

AND THE DRUG COMPANIES ARE GOING

TO PLAY INTO THE STORY OF

COURSE.

BUT THAT'S A BIT WHAT THE DRUG

COMPANIES WOULD LIKE US TO

BELIEVE BECAUSE IT MAKES FOR A

NEAT KIND OF PACKAGE.

>> Emily: OF COURSE, I WAS

RIVETED BY YOUR CHAPTERS ON

PRESCRIBING THESE PSYCHOTROPIC

DRUGS FOR CHILDREN.

WE HAD THAT HORRIBLE REBECCA

REILLY CASE, WHERE CLEARLY, THAT

DOCTOR REALLY PERFORMED

MALPRACTICE IN PRESCRIBING THE

DRUGS FOR THE 4-YEAR-OLD AND HER

SIBLING, WHATEVER IT WAS.

DIAGNOSING A 2-YEAR-OLD WITH

BIPOLAR DISORDER?

>> IT'S HARD TO SAY

MALPRACTICE --

>> Emily: I SAID IT.

>> YOU SAID IT, BUT CLEARLY WHAT

HAPPENS IN THE CASES IS PARTLY

IT'S THAT THE PARENTS ARE SO

FRUSTRATED, YOU KNOW, THEY WERE

DISILLUSIONED.

>> Emily: THEY WERE PATHETIC

TOO.

THEY WERE LOOKING FOR --

>> YEAH.

I THINK THAT IN OUR RUSH TO COME

UP WITH SOLUTIONS, WE ARE

DEFINITELY OVERDIAGNOSING

CHILDREN WITH VERY SERIOUS

MEDICAL AND PSYCHIATRIC PROBLEMS

AND AGAIN, SINCE WE DON'T REALLY

UNDERSTAND THE BIOCHEMISTRY ON

THE DISORDERS I THINK WE'RE ON

SHAKY GROUND, PARTICULARLY WITH

THE CHILDREN AND THE RATE OF

DIAGNOSIS OF BIPOLAR HAS GONE UP

8,000% OVER TEN YEARS.

THAT'S A LOT.

IT'S NOT BECAUSE THERE'S BEEN AN

EPIDEMIC OF THESE DISEASES.

IT'S BECAUSE THE CULTURE OF

PSYCHIATRY HAS CHANGED OVER TIME

SO THAT WE'RE LOOKING TO

DIAGNOSE --

>> Emily: AND INFLUENCE THAT YOU

WERE SO HONEST ABOUT, THE

INFLUENCE OF THE DRUG COMPANIES,

YOU ADMIT YOU TOOK MONEY FROM

DRUG COMPANIES TO BE ADVOCATES

ON CERTAIN THINGS.

>> OH, YEAH.

>> Emily: YOU'RE AGAINST THAT

RESTAURANT BILL.

>> I KNOW.

>> Emily: THE OVERTURNING OF THE

RESTAURANT BILL.

>> BECAUSE I WAS RIGHT THERE IN

THE RESTAURANTS TRYING TO

CONVINCE PSYCHIATRISTS TO

PRESCRIBE, AND PRESCRIBE AND

DIAGNOSE AND DIAGNOSE AND I SAW

THAT THEY WERE MARKETING TALKS,

AND NOT EDUCATIONAL TALKS.

SO I SUPPORT THE BAN.

YEAH, THERE ARE SO MANY FACTORS

AT PLAY RIGHT HERE.

YOU HAVE THE PHARMACEUTICAL

INDUSTRY ENCOURAGING US TO

PRESCRIBE.

YOU HAVE THE INSURANCE COMPANIES

WITH THE FINANCIAL INCENTIVES

AND THEN YOU HAVE THE PATIENTS

THEMSELVES WHO ARE TRYING TO GET

THE QUICK FIX.

THE QUESTION IS WHY CAN'T WE GET

OUR PROFESSION TOGETHER TO BRING

MORE THERAPY INTO THE

CONVERSATION WITH OUR PATIENTS

EVEN WITH ALL THESE PRESSURES

THAT ARE SORT OF MOUNTED AGAINST

US?

>> Emily: A GOOD QUESTION.

I HOPE YOU ANSWER ITS FOR US.

"UNHINGED".

THANK YOU FOR COMING.

WHEN WE CONTINUE, THE LOCAL

ACTRESS WHO'S PART OF THE

"TWILIGHT" SAGA.