Back when we rode our dinosaurs to the hospital, psychiatrists had one patient care philosophy for treating our patients: To help them live their best possible lives.
If our patients were schizophrenic, we wanted them to be as psychosis-free as possible. If they were depressed, we wanted them to be happy. If they suffered from obsessions and compulsions, we wanted them to be free of the forces that drove them to needlessly repeat thoughts and actions instead of living their lives.
Today, most psychiatrists are corralled into a fake patient care philosophy that tries to convince us that the only treatment required is to keep our patients out of the hospital. Anything else we can do for them is optional and - most importantly - not reimbursable.
The standard of care has changed since I became a psychiatrist. As long as the insurance companies are protected from having to shell out big bucks for inpatient treatment, the well-being of the actual human beings we are treating is not really important.
We have been indoctrinating young psychiatrists into this patient care philosophy for so many years now that most psychiatrists actually believe it. And this philosophy must change.
There is no magic medication that can give a person a happy life. There is no magic medication that can solve a person’s financial problems, relationship problems, academic problems. There is no magic medication that can address anyone’s existential issues.
Medications can treat the symptoms of different psychiatric disorders, but they do not treat the person.
When psychiatry was first developed as a separate field of medicine, the whole premise was that each individual had a unique history, with unique experiences, perceptions, and reactions, that rendered him or her - well - unique.
The goal of psychiatry as introduced by the father of psychiatry, Sigmund Freud (himself a neurologist) and later refined by generations of other psychiatrists, psychologists, and neurologists, was to tailor treatment to each individual patient.
The original philosophy of patient care was that each person who suffered from some psychic pain could be helped to recover and live his or her best life and go on to achieve all of his goals and dreams, free from the burden of mental anguish.
So what have we accomplished today, in the twenty-first century? We have developed a bunch of medications, many with a plethora of side effects. We have created a pretend treatment called “medication management.”
I often have students in my office. They are usually surprised to hear that I never ask my patients “how’s the medication?” That is because I am one of the few psychiatrists left in the world who knows that no patient has any idea how their medication is!
Would you go to your internist for your blood pressure and expect to hear “how’s the medication?” How about for your gout, or your ulcerative colitis? No? You might be asked, “how’s your pain?” or “have you been checking your blood pressure?”
Psychiatry has become so marginalized despite its quest for parity that even psychiatrists now believe that “how’s the medication?” is a legitimate question.
Let me tell you something: It’s not. I ask my patients how they are doing. There are specific questions I ask to find out if the medication is working the way it’s meant to. But that’s only a start.
Medication is like the sanding and spackling a good painter would do to a wall before painting on the color of your choice. It’s the base layer. After that needs to come the real work - the therapy that will help the patient become the true person he or she wants to be.
So why does the patient care philosophy of psychiatrists need to change? Why isn’t it enough to ply the patients with all our new miracle drugs and send them on their way?
One reason it needs to change is that the true, adjusted suicide rate today is about twice what it was only fifty years ago. Despite the availability of all the magic medications, people are killing themselves at unprecedented rates. I believe it is because we are asking pills to do the work of people.
We are over-medicating people who actually need to learn self-love. Self-love is the sanding and spackle. We live in a society where we are taught that we are only lovable if we look a certain way, dress a certain way, and spend a certain way. We are constantly bombarded with information on a million different platforms all designed to show us how we don’t measure up because we are not as good and worthy as the fake people we see on the screens surrounding us anywhere we look. Instead of bringing us closer together, social media is creating isolation and loneliness.
The biggest irony I learned about the history of media is this: Right after Sigmund Freud, the father of psychiatry, discovered that we all have a basic need to love and be loved, his own nephew, Edward Bernays, moved to the United States and figured out how to monetize this concept. Edward became the founder of public relations and advertising.
So what can we do to go back to basics? How can we serve our patients’ need to love and be loved?
In my own personal quest to learn how to better serve my patients, I discovered the field of life coaching. Life coaching is not yet standardized, so certification can be hit or miss.
But the philosophy is fairly standard: We focus on the patient’s, or client’s, goals and desires, rather than patching up the problems in order to keep people out of the expensive hospital. This philosophy is suspiciously similar to the original goal of Dr. Freud and all of his followers in the first hundred years of psychiatry, before big insurance took over!
I carefully evaluated a great number of programs and decided to train as a life coach. I’m no stranger to hard work, and I found that my understanding of neuroscience and medication has been a great help and foundation.
Now my patient care philosophy is this: We conquer our past and we create our best future. Sometimes we might need some medication, and that's okay.
We can all create a life we love living!
Until psychiatrists move their philosophy away from keeping patients out of the hospital and toward creating a life they love living, we will continue to have both unhappy, dissatisfied patients and unhappy, dissatisfied psychiatrists.
I invite every single one of you to consider working with a life coach to create a life you love living. And a psychiatrist who is also a life coach? Few and far between, but definitely available! Sign up for a free vision workshop or a free strategy session for more information! Spackle up your wall, and paint it any color you want!! The time is now!!