In response to the competition for patients and the prospect of managed health care, mental-health practitioners are engaged in an ongoing - and fruitful - debate about therapies. Unfortunately, two unhealthy, extreme positions have emerged. The first is the so-called "medical model" of mental illness: the belief that all mental illness is biochemical and therefore treatable with medication.
The second position is taken by those who advocate the "talking cure"; they believe that all emotional problems are caused by painful experiences and can be healed only if sufficient time is allotted for psychotherapeutic intervention.
The controversy exemplifies the age-old problem of "nature versus nurture" in science. The "medical model" represents the "nature" end of the spectrum while the "therapy only" position ascribes all emotional or behavioral problems to deficiencies in "nurture."
The solution to patient care will reject either extreme.
The most rigid adherents of the medical model, usually psychiatrists, claim that patients fall neatly into the diagnostic categories described in the "Diagnostic and Statistical Manual," and that these conditions have biochemical or genetic causes and so are amenable to treatment with medication. Enthusiasm for this view grows as more studies show correlations among genetics, brain physiology and human behaviors.
This "medical model" represents not only a naive reliance on a nature-based, biochemical treatment but also an understandable human wish for a cure, a pill to alleviate the pain.
As an experienced psychotherapist, I have seen the "fallout" from psychiatrists' overzealous application of the medical model. A patient once told me that she had seen a a psychiatrist for four years for depression. He had prescribed combinations of anti-depressants and anti-anxiety medications, but nothing seemed to help her. The patient saw the doctor weekly for 15-minute sessions at a rate of $125 per hour, but she complained that he never once asked about her daily life, her relationships or how she coped with the world.
After months of psychotherapy without medication, the patient understood that losses and psychological damage in her life provided sufficient basis for feeling sad. Depression was a result of life events, not merely a biochemical disorder.
Ultimately, all of our thoughts and feelings are brain-based and therefore biochemical at the molecular level. But a person's emotional life is more complicated than a purely biochemical problem, such as diabetes, which is easily medicated. Psychotherapy and psychiatry are baby sciences, still in the Dark Ages compared to physics and astronomy. Much is still not known.
Psychiatrists may decry the lack of medical knowledge on the part of non-medical professionals, such as clinical social workers and psychologists, and they have a good point. …