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Media Psychiatry

ByLawrence B. Erlich, M.D. - Email: Phila57387@aol.com

The public knows little or nothing about what psychiatry is, and what makes the situation much worse is the fact that the public has been made to believe endless amounts garbage and nonsense about psychiatry by the media. When you examine a psychiatric expert witness, you have to keep in mind that he will be testifying about the real medical specialty of psychiatry while the jury and very possibly the judge will expect to hear that garbage that they have seen in the movies, on TV, and read in the newspapers. Let me illustrate the point by considering how a typical patient would be handled by a real psychiatrist and then by contrasting that with the way the same "patient" would be handled in a movie or a soap opera.

Consider the following patient: She is a woman of 38. She has two children and a husband. She works in advertising and is doing very well. She has had several recent promotions and she is well regarded in her field. As a child she was sexually abused consistently by an uncle and thoughts about that experience intrude into her mind a few times a year accompanied by loathing and bitterness. However, in general the memory does not bother her that much. Gradually, that changes. She starts to dwell on her memories of her sexual abuse. She gradually gets to the point where she spends most of the day thinking about the sexual abuse. She cannot concentrate on what she is doing. She has crying spells and insomnia. If she is asked if she is depressed and she answers,"Wouldn't you be depressed if you had been abused the way I was?"

At this point she is sent to a psychiatrist. If this had been a soap opera the "psychiatrist" would put her in psychotherapy or psychoanalysis. She would come to him and talk about her "problem" on a regular basis. The events of the abuse would be dealt with over and over in increasing detail. There would be flashbacks and they would be as graphic as the medium would allow. There would be several suicide attempts, and the patient would recover if the actress' contract was renewed, or she would die if her contract was not renewed.

In real life the situation would be much less dramatic and much less drawn out. The psychiatrist would interview the patient and most likely make the diagnosis of a major depression. He would prescribe an antidepressant. The patient would ask if she needed more than just an antidepressant. "What about psychotherapy?" She would ask.

quot;Shouldn't I spend some time talking about the childhood trauma?" The psychiatrist would tell her that psychotherapy for childhood issues is not very effective while a patient is acutely depressed, but that if she still was bothered with thoughts about the sexual abuse after the depression was treated, she could get therapy then. What I tell my patients is that about one in 20 patients actually need therapy after the depression is treated. I tell them that patients never get answers to the questions that they ask when they are depressed, they just forget about their questions.

Since most patients respond to any antidepressant, it is fairly safe to predict that about three weeks after the start of treatment the patient will feel pretty good and about three weeks after that she will feel very much like her old self. At that point I might ask the patient if she still wants psychotherapy. The patient will ask how long the therapy will take and how much it will cost. I would tell her that the therapy will take a year or two at once or twice a week, and that it is not cheap. Even if she has insurance, the copay can add up. At that point she will probably say that the cure is worse than the disease, since she now only thinks of the abuse every few months. She has a busy life, and she does not have the time for therapy nor does she want to spend the money.

The purpose of medicine is to make sick people into well people. The purpose of drama is to be dramatic. There is nothing dramatic about a patient going to a doctor with an illness, getting a pill, and getting better. There is no place for real psychiatry in the media.