Pharmacological Treatment of College Students With Psychological Problems . Leighton C. Whitaker & Stewart E. Cooper (Eds.). Binghamton, NY: The Haworth Press, 2007, 271 pp., $56.00 (hardcover), $32.00 (softcover).
This is an unusual look at the current college handling and treatment of students with emotional problems from the view of the college and university health center. In particular, this book provides a unique and well-rounded perspective of the increasing use of psychiatric medications on the college campus. This book has been simultaneously copublished as the Journal of College Student Psychotherapy, Volume 21, Numbers 3 and 4, 2007. Whitaker and Cooper have brought together a collection of experts in the field of the treatment of college students to discuss the influences contributing to the dramatic surge in medications along with the biologically oriented "new psychiatry." They have brought together diverse points of view, thereby creating a forum for opposing views.
Howard Blue, Louis Sanfilippo, and Christopher Young, all psychiatrists from Yale University, discuss the critical need for careful histories, diagnostic clarity, and having clear aims for any pharmacological intervention. They stress the use of pharmacotherapy to target specific symptoms, such as improvement of mood, and that patients should be told of all the potential side effects of these drugs. They stress the need to distinguish between the depressed phase of bipolar depression and nonbipolar depression, although they rely on the DSM-IV 's fuzzy definitions to determine this. Blue, Sanfilippo, and Young represent, perhaps, the most promedication view in this field of authors. In a more moderate projection, Gerald Amada, the director emeritus of mental health programs at the City College of San Francisco, examines the general quality of the prescribing policy for college students and calls for more caution, more counseling, more disclosure of the side-effects of medication, and a greater focus on counseling. On the one hand, Amada points out that research has shown that quick symptom reduction with medication often tends to subvert insight and prematurely disrupts the very symptoms that are needed to sustain an analysis of them, and this results in a feeling that the student will always need an artificial crutch. In contrast to this, however, he posits that drugs may also work synergistically with psychotherapy and facilitate access to psychotherapy by dulling the interference of disruptive symptoms. Stewart E. Cooper, director of counseling services at Valparaiso University, also assumes an integrative model, discussing the use of both pharmacotherapy and psychotherapy. In this program, they start with psychotherapy and then use their medication consultation service only for those patients who are actively involved in psychotherapy. The program uses nurse practitioners to provide follow-up for uncomplicated cases, which lowers their costs. Cooper also feels that the trend of augmenting psychotherapy with medication is a trend that is likely to increase. While the medication-favorable side of this issue is represented by this group, the less medication-friendly group is represented by Henry C. Emmons, consultant to seven Twin Cities college counseling centers, M. Gerard Fromm, director of the Education and Research Center at Austen Riggs, and by Gertrude Carter, the former director of Psychological Services at Bennington College. Dr. Emmons describes depression in college students as a holistic illness, and his aim is to provide a more comprehensive and effective approach to treatment and prevention. In doing that, he rejects the reductionistic assumption of modern-day psychiatry. Em-mons points to three main factors that erode one's inborn resiliency. These are physical depletion or toxicity; unattended emotions; and the belief that one is disconnected from others and feelings of isolation and not belonging. He states that the factors involved in the increase in depression and loss of resiliency over the past 100 years include exposure to environmental toxins, dietary factors and obesity, inadequate intake of vitamins and minerals, ingesting saturated and hydrogenated fats, and lack of adequate sleep or exercise. …