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.
Labels: anti-depressants, Baskin Robbins, CBT, dance, DBT. Behavioral, depression, Equinox, exercise, Freud, Jung, mental disorders, psychiatrists, psychoanalysis, psychology, psychotherapists, shrinks, Skinner, Woody Allen
