Mental health services should prioritize talk therapy

In my first few days here at Vassar College, I had a panic attack, which is nothing new for me and is something that I have dealt with independently for a long time. What was new, however, was the fact that at my mandatory session at the Health Service, I was immediately pushed into trying medication. The topic was brought up two sentences before the counseling center was even mentioned.

Like many other surprises I had already dis- covered as an international student here (every- one uses letter-size paper instead of A4, there are soda machines everywhere, you don’t enunciate half of the t’s in the word “tater tot”), medication as the first line of defense for mental health issues seems to be something that is uniquely American. So much so, in fact, that Americans make up less than five percent of the world’s population but consume a majority of the world’s psychological medications, an extraordinary 66 percent (The Guardian, “Profiting from mental ill-health,” 03.15.2011).

Clearly, this phenomenon is not just unique to Vassar, but rather exists across the United States. In a country such as this one, where the government doesn’t pay for healthcare, patients who are dealing with mental disorders must turn to what their insurance covers—which most of the time is drug therapy, not talk therapy.

Talk therapy, otherwise known as psychotherapy, is based on the idea that discussing things that are bothering the patient helps to put those things into perspective and clarify the issues at hand, whereas drug therapy or medication therapy focuses on using psychoactive medicine to treat the patients’ symptoms. Traditional psychiatrists would usually have talk therapy sessions with their patients, lasting for around 45 minutes, treating 50–60 patients a week. Nowadays, many psychiatrists treat thousands of people in 15-minute sessions that are often many months apart (The Guardian, “Profiting from mental ill- health,” 03.15.2011). In fact, a government study in 2005 demonstrated that only 11 percent of psychiatrists offer talk therapy, a rate that has been falling since and is likely continuing to fall (Arch Gen Psychiatry, “National trends in psychotherapy by office-based psychiatrists,” 08.04.2008). This is no surprise considering that, in America’s private healthcare industry, what happens in the market is dictated largely by insurance, and insurance reimbursement rates and policies tend to discourage talk therapy and promote drug therapy instead.

Furthermore, a psychiatrist would earn significantly more money from a drug therapy session than a talk therapy session. An example quoted in The New York Times suggests that a psychiatrist would earn approximately $90 for a 45-minute talk therapy session, but $150 for three 15-minute drug therapy sessions (The New York Times, “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy,” 03.05.2011). It is therefore no surprise that the mental health services in this country are leaning more and more toward drug therapy. An interview with Dr. Richard Friedman, the director of the Psychopharmacology Clinic at Weill Cornell Medical School, reiterated the idea that market forces drive this shift toward drug therapy. Although he does suggest that some change has come from better understanding of the basic mechanisms of brain function and developments in neuroscience, he believes that the shift occurred largely due to market forces, mainly in the ways how insurance is administered (NPR, “Psychiatrist Shift Focus to Drugs, Not Talk Therapy,” 10.22.2012).

In truth, the problems with mental health in America have become an epidemic, and the switch from talk therapy to drug therapy hasn’t done much to slow it down. There is overwhelm- ing evidence demonstrating that psychological medications fail at restoring mental health. In

fact, a study by Harvard professor Irving Kirsch demonstrated that most, if not all, of the benefits from antidepressants are caused by the placebo effect, meaning that antidepressants typically work no better than a placebo. Some antidepressants increase serotonin, some maintain the same level and some decrease it (Z Psychol, “Antidepressants and the Placebo Effect,” 02.28.2015). Plus, side effects such as nausea, constipation, in- creased anxiety and even thoughts of suicide are among the reasons to caution against using drug therapy as the first line of defense when it comes to mental health (BBC, “The ‘extreme’ side-effects of antidepressants,” 10.19.2016). Talk therapy, on the other hand, does not have these kinds of side effects, despite its ability to change brain and body chemistry (ScienceDaily, “Talking therapy changes the brain’s wiring, study reveals for first time,” 01.17.2017).

Furthermore, many studies have shown that for some mental disorders, particularly those associated with anxiety, talk therapy may even be more beneficial than drug therapy, in addition to being free of such side effects. A study published by The Lancet Psychiatry found that cognitive behavioural therapy (CBT) was more effective than medication in treating patients with social anxiety disorders. The study also suggested that the benefits of talk therapy, CBT in particular, may continue after treatment ends, whereas people who suffer from social anxiety see a worsening in their symptoms after discontinuing medication (The Lancet Psychiatry, “Psychological and pharmacological interventions for social anxiety dis- order in adults: a systematic review and network meta-analysis,” 09.25.2014).

Not only is drug therapy not as effective as many doctors and patients believe, but the companies behind these drugs have also much left to be desired in terms of corporate social responsibility. An article published by The Guardian in 2011 claims that of the 30 different brands of anti-

depressants on the American market, all of them have suffered lawsuits within the first five years of becoming available (The Guardian “Profiting from mental ill-health,” 03.15.2011). For example, Eli Lilly & Co., the creator of Fluoxetine, also known by brand names such as Prozac, was faced with a high-profile federal lawsuit in the 1990s af- ter a man murdered his co-workers and then proceeded to commit suicide, actions which the law- suit claimed were caused by Prozac (Drugwatch, “Prozac Lawsuits,” 08.24.2018).

Furthermore, the same Guardian article has stated that all of the major healthcare companies who sell drugs to treat mental illness have been, or are currently being, investigated for healthcare fraud. Despite the clear issues they pose to society, antipsychotics continue to make the pharmaceutical industry over $14 billion a year. In fact, Xanax, an anxiety medication, generates more revenue than Tide detergent (Charles Barber, “Comfortably Numb,” 02.05.2008). In a system where selling drugs leads to billions of dollars in profit, pharmaceutical companies may find it easier to ignore lawsuits and investigations and just keep producing these psychiatric drugs, as there is clearly a market for them.

Everyone’s individual experience with mental health is different. For some people, medication may work, and for others it may not, or its side effects may outweigh its benefits. It is up to the individual to decide what is right for them. However, medication should not be treated as a mag- ical Band-Aid, nor should anyone feel pressured to follow a path that he/she/they does not feel is right for them.

We as Vassar students are fortunate enough to be able to see counselors, attend group therapy sessions and participate in workshops for free. Thus, we should not have to become victims of the status quo dictated by big pharmaceutical corporations who focus primarily on profit over people.

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