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America Has Reached Peak Therapy. Why Is Our Mental Health Getting Worse?

In most medical specialties, doctors use objective data to make their diagnoses and treatment plans. If your blood pressure is high, you’ll get a hypertension drug; if cancerous cells turn up in your biopsy, you might start chemotherapy. Psychiatry doesn’t have such cut-and-dry metrics, though not for lack of trying. Under Insel, numerous NIMH research projects aimed to find genetic or biological underpinnings of mental illness, without much payoff. Some conditions, like schizophrenia, have clearer links to genes than others. But by and large, Insel says, “we don’t have biomarkers. We don’t have a lot of things that you would have in other parts of medicine.”

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 Back to the future: Psychedelic drugs in psychiatry

According to Michael Pollan, "for most of the 1950s and early 1960s, many in the psychiatric establishment regarded LSD and psilocybin as wonder drugs" for treating depression, anxiety, trauma, and addiction, among other ailments. As these drugs came to be associated with the 1960s counterculture, and as stories began to surface about bad trips and psychotic breaks, "the exuberance surrounding these new drugs gave way to moral panic." Now the pendulum is swinging back, and the interest in their usefulness as a tool to help treat a variety of psychiatric conditions is rapidly growing.

Articles of Interest

Can Digital Psychiatry Really Fill the Mental Health Care Gap?

When you first consider digital psychiatry, you might think about the laundry list of apps ready to download on your smartphone: Calm, Headspace, Sanvello, Bearable, Happify and many others with similarly cheery names. These apps are personal assistants of sorts, helping users engage in guided meditations, mindfulness exercises, anxiety management and other activities, with customized wellness plans based on user preferences and lifestyles. While most of these apps offer free versions, accessing the full range of content—particularly the personalized tools—requires subscriptions ranging between $27.99 to $350 per year.

How 1 Study Changed The Field Of Psychiatry Forever

NPR's Ari Shapiro speaks with Susannah Cahalan about her new book, The Great Pretender, which tells the story of a landmark study that transformed the field of mental health.

Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

The shift away from psychoanalysis in the latter part of the 20th century was accompanied by key scientific and clinical advances, including the introduction of a wide range of evidence‐based pharmacotherapies and psychotherapies for the treatment of mental disorders. However, there has also been an extensive critique of pharmacological and cognitive‐behavioral interventions, whether focused on concerns about their “medical model” foundations, or emphasizing the need to build community psychiatry and to scale up these treatments globally.

Psychiatry of the Future – 2030 and Beyond

Psychiatry, like all medical specialties, is in the process of major changes. Psychiatrists and other clinicians must work together to ensure that the future practice of psychiatry will be relevant and useful to the population of tomorrow’s world. It is time to look at where this medical specialty is now and to try to imagine its future over the next decade.

Psychiatry’s Guide Is Out of Touch With Science, Experts Say

Decades of spending on neuroscience have taught scientists mostly what they do not know, undermining some of their most elemental assumptions. Genetic glitches that appear to increase the risk of schizophrenia in one person may predispose others to autism-like symptoms, or bipolar disorder. The mechanisms of the field’s most commonly used drugs — antidepressants like Prozac, and antipsychosis medications like Zyprexa — have revealed nothing about the causes of those disorders. And major drugmakers have scaled back psychiatric drug development, having virtually no new biological “targets” to shoot for.

So You Want to Be a Psychiatrist

So you want to be a psychiatrist. You like the idea of being a shrink, doing talk therapy, and having people all figured out. Let’s debunk the public perception myths of what it means to be a psychiatrist, and give it to you straight. This is the reality of psychiatry.

Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy

Medicine is rapidly changing in the United States from a cottage industry to one dominated by large hospital groups and corporations, but the new efficiencies can be accompanied by a telling loss of intimacy between doctors and patients. And no specialty has suffered this loss more profoundly than psychiatry.

Telepsychiatry Is Leaving Behind the Most Seriously Mentally Ill

Telepsychiatry was developed specifically to open up new avenues of care for underserved populations: the severely depressed who struggle to get out of bed, prison populations, and those in poverty or in rural areas. Telepsychiatry differs from teletherapy in that psychiatrists offer medication management in addition to talk therapy. In the early 2010s, telepsychiatry startups promised ease and convenience via the internet and mobile apps. Telepsych has expanded since then, but the rise in the past few months has been meteoric. Psychiatrists rushed to change guidelines and adapt to caring for patients in the stark absence of in-person interaction.

The Changing Face of Psychiatry

What a shame that many psychiatrists should relinquish psychotherapy when research has shown that psychotherapies work as well as medications for many disorders. What a shame that insurance companies should drive many psychiatrists to conduct medical-student-style interviews that miss — and at times intentionally ignore — the crux of patients’ problems.

The Future of Mental Health

Smithsonian magazine brings you stories about the latest advancements in treatments and understanding of mental illness.

The Future of Psychiatry as Clinical Neuroscience

Psychiatry is grounded in clinical neuroscience. Its core mission, now and in the future, is best served within this context because advances in assessment, treatment, and prevention of brain disorders are likely to originate from studies of etiology and pathophysiology based in clinical and translational neuroscience.

The mind-body experience and the future for psychiatry

The enteric (gastrointestinal) nervous system has long been recognised as the body’s “second brain”, with colloquial phrases such as ‘going with your gut’ or feeling ‘butterflies in your stomach’ being common parlance. Scientific evidence has legitimised these expressions, and accumulating evidence supports the critical importance of the mind-gut interface. Some conditions such as irritable bowel syndrome (IBS) are known to have an important psychological component. This leads many clinicians to simply dismiss their patients as having medically unexplained symptoms.

The War For The Future Of Psychotherapy

Maybe you heard. There’s a war brewing. At stake is the future of psychotherapy. Will manuals, algorithms, and automatons prevail? Or will we be able to preserve the centrality of unique and responsive human relationships? The fight will determine the kinds of care available to people with problems in living. And you better pay attention. This fight concerns you; after all, who doesn’t have such problems at some point in life, or care about someone who does?

What Will the Psychiatrist of the Future Look Like?

Many people will point to technology, but Aggarwal noted that while virtual care can help with the distribution of mental health resources across the country, it doesn’t improve the capacity problem. Several talks at this year’s meeting will focus on artificial intelligence (AI), but Aggarwal believes AI is still too immature as a technology to consider its potential in bridging the need gap.

Resources

7 Predictions on Psychiatry's Future: Experts Weigh In

The allure of a 'magic bullet' in psychiatry is undeniable. However, as Andrew Penn emphasizes, the complexities of the mind (and soul if we look at the latin root of “psychiatry”) require a more nuanced approach.Effective psychiatric treatment, especially with psychedelics, doesn't necessarily eliminate an ailment. Instead, it may reshape a patient's relationship with it. For example, for Penn’s patient, an MDMA-assisted therapy didn't "cure" her PTSD, but rather it transformed her relationship with her trauma. Her trauma no longer ruled over her life.

Psychiatry as a medical specialty: challenges and opportunities

Technological advances in detecting brain signals via magnetoencephalography, magnetic resonance imaging, positron emission tomography and other methods, and advances in psychiatric therapy also increased the need to define the specialty and its specific diagnostic and therapeutic methods.