Even an apparently simple therapeutic situation often involves deeper problems. A man came to therapy after sustaining a work-related injury: parts of several fingers were severed from one of his hands. He was having difficulty adjusting to this loss and associated discomforts and limitations. After several sessions, he finally addressed his primary complaint with a blatant statement: he suddenly barked out hostility towards his wife who “forced him to take the job” that led to his industrial accident. Ultimately, in his mind, the reason for his injury was simple: his wife was to blame. This assignment of blame makes it clear that he was not simply upset with his hand injury; there were also many complex structural problems in his personality and marriage.
One of the most common applications of simple solutions to complex problems involves the use of psychiatric medication. Not only is taking pills a simple approach, but it is also convenient. Go to your primary care physician (PCP), or ask a medical specialist or a psychiatrist for assistance. In most cases, a prescription is forthcoming rather quickly, because most psychiatric medication is prescribed by non-psychiatric physicians, often the PCP. Both the PCP and patient accept that medication is the answer to psychological issues. Often, of course, this is not the case, and the result could be the beginning of a long series of multiple-drug treatments, none of which seem to work.
We are not saying that many patients do not benefit from medication, nor are we saying patients are always better served by psychiatrists in dispensing psychiatric medication. We are, however, questioning whether patient needs are being reviewed in a holistic and optimal fashion benefiting their long-term interest. For example, physicians generally do not ask necessary questions like these before writing a prescription for an anti-depressant: Is the patient clinically depressed or simply unhappy? Does the patient really suffer from depression, or are the problems related to anger or anxiety that make them look depressed? Does the patient need referral to a specialist such as a psychiatrist or psychologist? Does the patient really understand all options, including psychological assessment and other specialized treatment tailored for specific difficulties and needs? Is there a thorough and critical evaluation of the diagnosis prior to treatment?
All too often, patients are put on one or more medications after a relatively brief interview. A subjective view of the patient, usually after one session, provides the basis for preliminary diagnosis and treatment. Prescribing psychiatric medication without any objective psychological assessment, however, is analogous to going to the PCP and being prescribed heart medications without the support of appropriate medical tests (lipid panel, EKG, CT scan, MRI, stress test, etc.) Even worse, are the explanations patients may be given to justify medications prescribed for them. These explanations are typically simplistic explanations for the difficulties the patients are experiencing. Certainly, there are treating physicians who are careful about developing working hypotheses regarding their diagnosis and treatment approaches, but many physicians and their patients believe psychological problems can be treated like some medical difficulties; if patients just take the right pill, they will be okay, just like when treated for bacterial infections. Psychiatric medications, however, treat symptoms; they do not cure. Also, there is a great deal of overlap between many of the diagnostic categories for psychological disorders, and treatment varies considerably based upon the type of diagnosis advanced. Everyone needs to proceed cautiously until diagnoses are made and confirmed. Unfortunately, this caution is frequently not exercised.
Psychology and Stress 