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Psychotherapy over Psychopharmacology

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My late psychiatrist, Dr. Michael McGrail, who passed away three years ago this month, was considered an authority on medication. He prescribed me Risperdal in late 1996 and told me that it would make me think in a more linear fashion, that it would help me be more productive. It did, but it could not prevent the psychosis and deep depression that deluged me in March of 1997.

After recovering from that break and returning to Los Angeles on Memorial Day weekend of that year, I explained to Dr. McGrail that I was paranoid about Risperdal, that I thought it had caused my psychosis. I was wrong, but so powerful was my paranoia that Dr. McGrail recognized that he would have to put me on a new anti-psychotic.

Dr. McGrail understood that patients are not only brain chemicals, that patients have emotions and feelings that can be more powerful than science. Though he sighed, he agreed to switch me to Perphenazine, which I took for more than a decade before transitioning to Abilify, a change in regimen that Dr. McGrail had broached before his death in May of 2007.

Notwithstanding his gifts as a psychopharmacologist, Dr. McGrail helped me most week after week with his compassionate, thoughtful and amusing therapy. Dr. McGrail started out just about every session with a joke. One day, after he saw my wife Barbara's fur coat, he made a crack about a certain fur-bearing animal known for its industriousness. It was admittedly in poor taste, but it set the tone for the humor and warmth that prevailed in his office.

As I have written elsewhere, he also told me about aspects of his past, such as the years he spent unemployed; he thought that would help me, since I was unemployed when we first met, so he revealed these details, even though strict Freudians would never have done so.

I mention all of this because recently the New York Times Magazine ran an article, headlined "Mind over Meds," in which the writer, Daniel Carlat, a psychopharmacologist, reached the conclusion that his patients required more from him than medication alone. He pointed out that studies have shown that "depressed patients given cognitive behavior therapy showed decreased activity in the frontal lobe, the brain center that might be responsible for the overmagnification of life's problems."

Carlat noted that many psychopharmacologists practice "fragmented care" in which they solely prescribe medication for patients while referring them "to a professional lower in the mental-health hierarchy" for therapy. As he put it, the "unspoken implication is that therapy is menial work -- tedious and poorly paid."

Coincidentally, my wife has just ended a long-term relationship with her own psychopharmacologist. Two Fridays ago, she missed an appointment with him because she threw up black residue at our house. I immediately phoned my psychiatrist, a wise and loving man, who told me that the black matter was almost assuredly blood. Upon learning this, I took my wife to the emergency room where we discovered that she had ulcers in her esophagus.

While at the emergency room, I phoned my wife's psychopharmacologist and left a message that she would be unable to make her appointment because she was ill and in the hospital.

Sadly, her psychopharmacologist never phoned our home to check in on my wife, never inquired about her health.

My wife later told me that this individual had often been cold and abrupt with her. When she had told him of her chronic fatigue, he had cast aspersions on her condition by interjecting, "It's grief, Barbara." When she told him on another occasion that she was having trouble sleeping and asked for a more powerful sleeping pill, he told her, "I could cut you off."

In light of Michael Jackson's death, we all know the dangers of taking too much sleeping medication, so there is no denying the need for caution in prescribing these meds. But there is also no denying that my wife deserved a more civil response on that occasion and many others.

It points to the arrogance of some psychopharmacologists that Dr. Carlat exposed in his article, the view that therapy is low in the food chain and not worthy of a scientist.

Carlat wrote near the end of his piece that "good doctoring...involves perfecting all the skills relevant to healing and deploying them when needed." I can only hope that in the future my wife benefits from the kind of balanced skill set and humanity that I received from Dr. McGrail and still get from my current psychiatrist.