The Real Adjustment Bureau

The Sunday Times ran a stomach-turning piece on American psychiatrists' selling-out to big pharma on its first page this week. In "Talk Doesn't Pay, So Psychiatry Turns Instead to Drug Therapy," which features a certain Dr. Donald Levin as the poster boy of this migration from the couch to drugs, we learn that the role of the psychiatrist in America today is to devote 15 minutes per patient in order to make "prescription adjustments," and avoid any kind of personal talk. We also learn that a psychiatrist's office is run pretty much like a 24 Hour Fitness membership services office: patients are clients and the more clients the better. Or like Ryan Air's infamous customer service motto: I don't care if your grandmother died, you are still paying the fee.

The article makes a few horrible mistakes such as never directly mentioning psychoanalysis, somehow lumping it together with psychiatry. Which is kind of like assuming Che and Reagan shared the same life philosophy. It says the 1970s were the heyday of talk therapy for psychiatry when it is precisely during that decade that analysts like Julien Israel took their most amazingly acerbic jabs at psychiatry for already being pals with the drug industry. Another expected error is the article's claim that "recent studies suggest that talk therapy may be as good as or better than drugs in the treatment of depression." This logic completely assumes depression to be a scientifically measurable thing one can gauge through perhaps checking boxes on a survey. This is exactly the kind of cringe-inducing counter-Freudian reasoning that makes one stick a pencil in the eye, this sense that the truth lies in whatever is latent, visible, easily legible and reportable.

But the most sickening bits is to read direct quotations from a psychiatry professional "mourning" the fact that he now, after ditching talk therapy because it's more profitable to see 40 patients a day (no joke) to prescribe drugs, feels "like a good Volkswagen mechanic." The psychiatrist doesn't know his patients names, rolls his eyes when another one comes in the office right when he thought he was done for the day, and makes his diagnostic in 45 minutes (the first session is 45 min., every other one is 15 min. maximum): "You have to have a diagnosis to get paid", he says. I mean, many a Lacanian analyst will send the analysand packing at the 12-minute mark, but as a methodological strategy.

In the world the Times paints for professionals of the psyche, even psychologists (which come off as guardian angels of reason, yet for psychoanalysis they wouldn't fall very far off the psychiatry tree) say that "Medication is important," just not everything.