Unfortunately the demand for psychotherapy has only declined as the (often patient-prescribed) demand for psychotropic medications have increased and equitable insurance has decreased. GP’s are frequently playing the roles of psychopharmacologists in treating depressed or anxiety-ridden patients. There is a great deal of data to support this but I only need to look at my own situation: I had to go-out-of-my-way to find a shrink who would accept me as a patient whilst I continued to take my PCP-prescribed Xanax. My PCP doc has treated me for 10-years and knows that I’m about as much an addict as an alcoholic: That is to say, I am neither. But, after entering my 34th year taking Xanax, I am dependent on it; I can’t get through a day without it. I don’t buy it or sell it, I’ve never taken more or less than that prescribed, and it’s that bespoke suit which draws so many well-wished-compliments that I wear as often as possible. I wallow in anxiety. Xanax helps. But only my PCP will prescribe it, now. Hence I agree with the ‘experts’ — as psychotherapy declines, the chairs are full of GP’s playing at first-year-MD-psychiatric-residents are more than willing to offer psychotropic medications. I’ve had this discussion with my GP... he will not script me for one antidepressant or a host of antipsychotics. I could call him an unethical crackpot for failing to meet my needs or I can (and do) credit him for not playing psychiatrist.

The majority of the decline-data seems fixated upon those who have no insurance. Psychotherapy is a pay-service, like the services of a Nephrologist, and if you lack insurance you are likely to forgo these services and find the very cheapest form of ‘treatment’ — and you know to ask for Prozac because it has such a wide audience (I don’t know of a book titled, “The Thorazine Nation,” for example). Or Abilify (with their overwhelming television commercials). The secondary-decline may be the lack of new medications from Big Pharma. Tricyclic antidepressants may work better than SSDI’s and Lithium remains the gold standard for mood-stabling drugs. The best medications may be the oldest. Why, yes, heroin does help my jitters!

While psychotherapy has seen a decline, psychiatric care has been in decline, too. Are both bad things? I’m not sure how to answer that — I think that I can say, as a one-time and to-be-continued research psychologist — that my greatest hope for we mentally disordered folks lies with neuroscience. The study of the living brain has long-passed the ability to produce laughter whilst stimulating one portion of the brain (in general, BSR) but neuroscience was only legitimised in the late 19th century. Because of it’s dependence upon psychology-as-science, it may be a challenge to psychiatrists and psychologists.

[An admission: my last experience with a Neurologist was horrible — I had a stroke during the Christmas week of 2016 (2015? I can’t remember!) and I had a hospital-appointed neurologist who suggested — with no evidence — that the stroke was due to a nefarious clot that had made it too my brain: I was rewarded with some over-priced and so overly-rare treatment that residents were crowding my ICU room to ask me how I was feeling. I was supposed to keep still for 24-hours, promised that I would sleep the time away and receive the same meds as I took at home. I didn’t and I didn’t. I roared like a profane lion for 24-hours and, not receiving my painkillers or any psych meds, my roaring became sacrilegious and litigious at the same time. Like a mad cardinal-attorney. And bound-and-gagged like Bobby Seale. I didn’t sleep the necessary 24-hours, etc. I probably did have an ischemic stroke but probably didn’t have a giant clot coursing through my body. I later learned that my assigned neurologist was a ‘pain management’ specialist in real life. End of admission.]

Anyway, that would be my bet if the angels were to relieve me of my red shoes. Honestly, though? I’m not sure of how much Luddite-inspired anti-science this nation can take. Maybe we’re locked into circa 1930-1950’s drugs. Maybe quetiapine, lithium and Thorazine will always be my night-night meds. The Luddites worry me. More and more, the Luddites worry me. I feel as if there might be established a new Know-Nothing party. I can only hope that I don’t see 2020. If I hear, “now I don’t know but I feel like...” chimpanzees feed in pecan trees, my head might explode.

I don’t think that it’s millions of websites promoting cures that are to blame but (paradoxically) the pharma television commercials. Yes, many people have internet access but (and I’m not even going to use an L/N search) I would guess that more people have commercial television access. And that they see how those taking Abilify seem so much happier at the end of the commercial that they may speak to their GP about feeling ‘down’ or ‘blue.’ A GP will know about their insurance and might prescribe Abilify or suggest Dr. Parsons, the psychiatrist, down the road. The next move is largely dependent upon the judgment of the community standards which may stigmatise psychiatric care or not. It may be the safest thing to say that therapy COMBINED WITH psychotropic drugs is best for most people suffering from difficult mental disorders.

(I would define difficult mental disorders as those that disrupt mental or physical behaviours. Or both. My mental behavioural disruption might be seeing my long-deceased father mowing the grass. My physical behavioural disruption might be walking along him and speaking to him as he mows.)

Not so much an admission, just an long-stated fact: between 1999-2003, I lived in a state-run mental health hospital. I think that I can say that I “saw it all” during that confinement. From 2005 to late 2011, I lived in the psychiatric ward of a nursing home. I was an all-night coffee-consumer and part-time hospice assistant. So much the latter that I would be requested to “watch me tonight? I feel like I might die.” They did. Maybe two-three in one week? All sorts of hospice nurses — I felt like throttling the unmerciful.

Psychotherapy is probably promoted as being efficacious because it is more efficacious than not. I’m going to lowball the lowballiest (that’s not really a word) and say that psychotherapy is 70% efficacious and that the percentage jumps when combined with psychiatric treatment.

I admit that I know nothing about “the match.” First that I’ve heard of the concept. I’m sorry to say that it seems like a “best friend” therapist search rather than finding a paid-professional efficacious therapist. The concept of best-friend therapy is anathema to me. The one time that I crossed that line my name and photo ended up in the newspaper and I never allowed it to happen again. I’m always amazed to read of people here who expect friendship with therapists when they would never expect the same from their dentists. Yeah, my shrink knows me more intimately than my dentist but I don’t expect birthday gifts from either. Come to that, my ex-wife knows me more intimately than my current shrink and she’s not even sent me a card in 23-years! My thought would be that I might be sicker than I think if I need to go through years of shrinks (therapists) to “find the right match.” I’ve never heard of that as an industry practice?

I guess that the worst thing that I can confess is that I’ve never actually been dismissed by a shrink. I’ve been referred to another shrink, mind you, but only because the number of my queer diagnoses were more the particular expertise of one shrink rather than the current. I don’t find that strange at all. Upon moving back here, my first GP was a friend. After a few months he said, “Krypto, I don’t know how to treat you — you need to see...” with a list of specialists in his hand. Had he not sent me to those specialists I would not be alive today. Why should a shrink be different? I may get a referral to a shrink specialising in eating disorders, ADHD, child and adolescent psychiatry. If not at our first meeting, at our second she will surely suggest that Dr. Crapshot, who specialises in bipolar, anxiety, schizophrenia and borderline personality disorders might be a better “fit” (or “match”) for me.

Maybe you would trust an MD/shrink to operate more judiciously than a PhD/therapist? I have no experience with ‘Counselors’ who may have MA’s, etc. I have no patience with those who’ve less university terms than me. Call me a psycho-snob. My single PhD/therapist was damned good, though. I liked him when he rolled his quadriplegic body out in his super-wheelchair. I liked him more when I told him that I thought that CBT was crap. We had a great professional relationship. I still like him. I just don’t have a ride to go out to his office. I’m back to an MD/shrink. She looks like the smartest/hottest woman in the world: Ana Marie Cox. Ana Marie Cox looks like Kirsten Dunst. My social worker swears that my ex-wife and Kirsten Dunst are twins. Me? I feel transference coming on (JOKE!!!).

I cannot find data that supports a patient spending years and years with a shrink/therapist only to discover that they’ve not been beneficial. I’m not disputing your analogy, particularly if it’s part of your personal narrative, I simply cannot find data to support that this is even peripheral datum. I am not trying to dismiss the harm and unethical behaviour that you’ve endured but I can’t find any studies that support that these behaviours are pandemic in this country. Or even reaching the level of epidemic. Or epizootic. (Give me a break! I never get a chance to use the -zootic words!!!).

I’m with you 100% when you write “So it seems to me some skepticism, questioning and balance is positive and healthy. After all, in the US at least, healthcare is a product of capitalism.”

As an atheist, you can expect skepticism from me; questioning, too. Balance? I’m ‘iffy’ on balance. Fox News may be balanced but I think that I’m too corrupt to be balanced. I’m close to your belief — I just think that capitalism drives healthcare rather than reverse. Unlike unethical attorneys (my bailiwick) I don’t see doctors advertising their services on billboards or on the sides of buses. It isn’t illegal (SCOTUS) — but it’s thought unethical (AMA). Conversely, Hospitals (AHA) spend a fortune on advertising. I’m sure that you can guess the largest healthcare industry advertising (questionably-worthy) products: Big Pharma. Only in the U.S. of A. And New Zealand. Healthcare is largely free — or heavily subsidised — in New Zealand, though. See PHARMAC. Or don’t.

I’m aware that doctors and associations “advertise” on the internet. Usually within the ethical parameters of the FTC and various medical associations. I find that unfortunate as I paid big money to copyright “Dyno-Gyno.” Nonetheless...

I’m not (yet) convinced that the health industry — or even the medicinal-weed-farming industry — doesn’t have the health of it’s patients at the core of the industry. “Bad doctors” usually don’t get referrals and, sans advertising and referrals, doctors don’t make money. Specialists, which include doctors of psychiatry and of psychology, have found it more lucrative to form associations than to set up single-shingle shops. I’ve found that practice sound as no association wants a ‘bad’ associate giving all the hurls because of one bad egg. There will always be — there cannot help but be — not just exceptions to the rule but even HUGE exceptions.

I think that this website can be a great place to have ones’ say but I’m not sure that even a couple of hundreds of threads constitute a movement to protect others from harmful or unethical psychiatric behaviours. NAMI, however, is an exceptional case of “grassroots done right,” and serves so very many mentally disordered folks that they would be the first line (to call — I couldn’t stop it) for reporting harmful or unethical treatment.

I feel the need to repeat this several times in these long messages: I do not doubt, I would never doubt, it’s not within me to doubt, that you and others have been harmed by the unethical treatment of therapists (MD, PhD, MA, BA, AA, certified, whatever). I’ve simply not been able to find data that supports that this treatment is in any way common. My experience, save for one short episode that I believe that I could have avoided, has been that all of my therapists have had >me< at the centre of my therapy and that all have acted professionally in treating me.

That’s it. Sorry for mistakes - I wrote this too quickly and let the spellcheck automatically correct misspellings.

Peace.