Mental illnesses are a leading cause of disability. They are expensive in lost productivity. They are also expensive in terms of an individual’s life satisfaction and well-being. Seven percent of total health cost in the United States is devoted to treating mental illnesses. Fifty percent of us will suffer from at least one psychological disorder over our lifetime. Unfortunately, only about one-third of patients experiencing a mental disorder receive adequate treatment.
In a column earlier this month I discussed psychotherapy. It is an effective method to treat mental health issues and stress. However, it is severely underutilized. Good psychotherapy restores a patient’s ability to function at work and at home. Yet the most frequent treatment for psychological disorders is medication without psychotherapy. This approach to treatment has many drawbacks.
Government and insurance company data show that nowadays more medications are used to treat mental health problems and psychotherapy is being used less frequently. This is a paradox because in many instances psychotherapy provides long lasting benefits, has none of the side effect of medication and is cost effective.
Why is this so? In part, this is due to our wish that a pill will provide a quick fix for mental health problems. But emotional situations are far more complex than a headache. While an aspirin may provide complete relief for some headaches, it will not provide lasting relief if there is a serious underlying cause of the headache. Just like an anti-histamine will provide symptomatic relief from an allergic reaction to pollen, it is only temporary because the pollen continues to be in the air. Medications for psychological disorders work the same way. They provide some relief. Medication for depression can reduce lethargy, fatigue and other vegetative symptoms. However psychotherapy is required to learn adaptive coping and life skills.
Pharmaceutical companies spend a huge amount of money advertising in print and electronic media extoling the benefits of medication for various biopsychosocial difficulties such as depression, anxiety, attention deficit disorder and erectile dysfunction. These are very well done and are quite convincing. There are no ads advertising the benefits of psychotherapy.
Unfortunately many of us learn about psychotherapy from movies, television sitcoms or cartoons. These sources of information provide distorted portraits of how psychotherapy really works. Many forms of psychotherapy are not the popular stereotype of a patient lying on a couch and talking about dreams. Also, contrary to popular belief, psychotherapy treatment most often does not continue for years. It more typically lasts for weeks or months.
A most disturbing trend is that in the past decade medication has become the most often used treatment for psychological problems. The ads by drug companies are working. Patients arrive at their doctor’s office asking for the latest pill for their self-diagnosed problem such as anxiety or attention deficit disorder.
Researchers Drs. Mark Olfson and Steven C. Marcus using data from a 1998-2007 nationally representative sample found an increase in the percentage of patients who see a doctor for a psychological problem and receive medication without psychotherapy. During the same time period there was a decrease in the number of patients who received psychotherapy. The percentage of patients who received a combination treatment of mediation and psychotherapy also went down.
So this is the puzzling issue. As more research accumulates showing that evidence based talking therapy is effective, fewer people are getting this type of treatment.
Martin Manosevitz, Ph.D., ABPP is a clinical psychologist and practices in Aspen. He provides services to adults, adolescents, couples and families. He is board certified in clinical psychology and in psychoanalysis. To contact Dr. Manosevitz call 925-2552 or email: mmanosev@earthlink.net