Shrinking Down

     Why weren’t psychotherapists included in my lament about all the time and money our family has spent on doctors? (See “Doctored Up,” 6/27/13).  The answer is both simple AND astonishing.  Thanks to the mind-boggling variety of practitioners we affectionately (and not-so-affectionately) refer to as “shrinks,” I firmly believe psychotherapists deserve a blog post (if not a book) of their own.  Psychiatrists, psychologists and psycho-pharmacologists all belong in the over-crowded category of shrinks.  To make matters even more complicated and confusing, there are many types of psychotherapy: Behavioral, Cognitive, (CBT) Dialectal, (DBT) Psychodynamic and Gestalt, to name just a few. And let’s not forget all of the psychological theories that have been essential to—or completely omitted from— the training and education of today’s mind doctors: Sigmund Freud, Carl Jung, B.F. Skinner, Carl Rogers, Erik Erikson…the list goes on and on.

     There are probably as many different types of shrinks as there are flavors of Baskin Robbins ice cream--especially if all the sub-specialties are included.  How do these therapists “specialize” in crazy? Just like regular physicians, shrinks often choose to work with specific demographics: children, adolescents, geriatrics. In addition, there are shrinks who specialize in drug and alcohol abuse, grief, marriage, divorce, family systems, and chronic illness. Some shrinks gravitate to patients who are crazy in different styles: bi-polar, manic, schizophrenic, psychopath, borderline personality disorder, along with the garden variety of patients suffering depression or anxiety. Some shrinks rely exclusively on “talk therapy,” while others combine medication with free-association and soul-searching.  What about the philosophical divide between those practitioners who fervently believe in long term therapy, versus those who ardently advocate short term therapy?

    In today’s world—if you happen to be anxious, depressed or even mildly crazy (whatever that means)—it must be incredibly difficult to select from the smorgasbord of shrinks out there.  Readers of my vintage who grew up in the ‘60s (when everyone still worshipped Freud) had only two real choices.  The first choice was psychoanalysis, where we stretched out on a couch at least 3 times a week, free associating and trying to understand dream symbolism in the reassuring presence of a shrink who mostly listened, asked questions and gently led us to an “Aha moment.”  Needless to say, psychoanalysis was an expensive, long term therapy that could go on for a lifetime. Anyone who saw “Annie Hall” may remember Woody Allen’s famous line.  After 15 years of analysis, he says: “I’m making excellent progress.  Pretty soon when I lie down on the couch, I won’t have to wear a lobster bib.”
     The second choice in the old days was psychotherapy—what I think of as the diluted, poor man’s version of analysis.  You went less often, sat in a chair, and often worked with a CSW or Phd psychologist  who was cheaper than a psychiatrist with medical training.  These psychotherapists often took a more active, confrontational approach and relied on an assortment of psychological theories.  Did either of these popular therapies work?  Definitely not, if you ask me or any baby boomer I know who consulted a shrink in their 20’s and 30’s.  What brought some relief to me and my friends was the introduction of Prozac and the other serotonin reuptake inhibitors.  Although not the panacea, at least Prozac and its descendants provided us with a legal “happy” drug.

     These days Americans spend $86 billion on anti-depressants, which are among the most commonly prescribed drugs, according to Google.  How much do we spend on shrinks?  A whopping $44 to 55 billion. You might also be shocked to learn from the NIMH that nearly 1 in 3 Americans (or 75 million people) suffer from a mental disorder.  These patients are served by over 552,000 mental health professionals (aka shrinks), whose main focus is the diagnosis and treatment of mental health or substance abuse concerns, according to statistics from the US Department of Labor.  Not surprisingly, the job outlook is strong for shrinks—especially for psychiatrists and professionals with a specific specialty.
     If you don’t believe that mental illness will impact your life, think again.  For all mental disorders, the lifetime prevalence rate is an astonishing 57.4%, more than 1 out of 2 Americans. That means even if you haven’t personally suffered from being crazy or depressed, a friend or family member has surely been diagnosed with a psychiatric disorder (surprise, surprise).

     So how do most people recover from depression?  According to Michael Conner, PsyD, “almost any strenuous exercise for 30 minutes three to five times a week can reduce or eliminate symptoms of depression.” On his list of recommended activities are:  strenuous walking, hiking rowing, biking, running or weight lifting.  Further, he contends that “combining exercise and psychotherapy is more effective than combining anti-depressants with psychotherapy." Conner insists only 15 – 25% or depressed people improve somewhat from taking anti-depressants.  Apparently, research “repeatedly confirms that 40 -50% of depressed patients get better because of the passage of time, fortunate events or changes they make in their lives.” Duh!   Evidently a successful shrink, Conner triumphantly concludes that “psychotherapy can empower people to make changes and incorporate exercise into their life.”

     I’m not sure I agree.  Personally, I find the right combination of exercise and anti-depressants more effective (and affordable) than exercise and psychotherapy. Of course I speak as a former patient of several shrinks, various therapies, assorted anti-depressants and different types of exercise.  A boring exercise routine does produce endorphins that lead to a greater sense of calm and well-being. And, yes, moving and sweating—however tedious—can be a temporary distraction from depression.  But that’s NOT a cure, at least not for me.  I set my sights higher than a brief endorphin lift.  I’d rather take dance class with Matthew Johnson on Mondays and Wednesdays at Equinox than see a shrink, lift weights or go running.  (See “Nest Escape, 5/16/14).  This dance class is exhilarating, uses choreography I can follow, music that’s upbeat, and an instructor who shares so much positive energy that he makes everyone feel young and alive.  On July 7th—his 27th birthday—he offered us a musical autobiography of his life.  And I’m not the only student who finds Matthew the dance teacher enchanting. Three women brought him birthday cakes. When class ended, he declared to all of us: “You are beautiful. You are strong. You can do anything!”

     Okay, so maybe it’s not 100% true, but these passionate words buoy my endorphin-raised spirits and keep me smiling much longer than 45 minutes worth of head shrinking insights and observations.

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