Farewell to the Couch
Articles in this series will examine recent shifts in medical care.
Sunday, March 6, 2011
my dear psychologists you're damn fool around
Talk Doesn’t Pay, So Psychiatry Turns to Drug Therapy
Richard Perry/The New York Times
“I had to train myself not to get too interested in their problems, and not to get sidetracked trying to be a semi-therapist.” DR. DONALD LEVIN, a psychiatrist whose practice no longer includes talk therapy.
By GARDINER HARRIS
Published: March 5, 2011
DOYLESTOWN, Pa. — Alone with his psychiatrist, the patient confided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and second marriage falling apart, the man said he needed help.
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Richard Perry/The New York Times
Dr. Donald Levin
But the psychiatrist, Dr. Donald Levin, stopped him and said: “Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.”
Like many of the nation’s 48,000 psychiatrists, Dr. Levin, in large part because of changes in how much insurance will pay, no longer provides talk therapy, the form of psychiatry popularized by Sigmund Freud that dominated the profession for decades. Instead, he prescribes medication, usually after a brief consultation with each patient. So Dr. Levin sent the man away with a referral to a less costly therapist and a personal crisis unexplored and unresolved.
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.
Trained as a traditional psychiatrist at Michael Reese Hospital, a sprawling Chicago medical center that has since closed, Dr. Levin, 68, first established a private practice in 1972, when talk therapy was in its heyday.
Then, like many psychiatrists, he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. Then, he knew his patients’ inner lives better than he knew his wife’s; now, he often cannot remember their names. Then, his goal was to help his patients become happy and fulfilled; now, it is just to keep them functional.
Dr. Levin has found the transition difficult. He now resists helping patients to manage their lives better. “I had to train myself not to get too interested in their problems,” he said, “and not to get sidetracked trying to be a semi-therapist.”
Brief consultations have become common in psychiatry, said Dr. Steven S. Sharfstein, a former president of the American Psychiatric Association and the president and chief executive of Sheppard Pratt Health System, Maryland’s largest behavioral health system.
“It’s a practice that’s very reminiscent of primary care,” Dr. Sharfstein said. “They check up on people; they pull out the prescription pad; they order tests.”
With thinning hair, a gray beard and rimless glasses, Dr. Levin looks every bit the psychiatrist pictured for decades in New Yorker cartoons. His office, just above Dog Daze Canine Hair Designs in this suburb of Philadelphia, has matching leather chairs, and African masks and a moose head on the wall. But there is no couch or daybed; Dr. Levin has neither the time nor the space for patients to lie down anymore.
On a recent day, a 50-year-old man visited Dr. Levin to get his prescriptions renewed, an encounter that took about 12 minutes.
Two years ago, the man developed rheumatoid arthritis and became severely depressed. His family doctor prescribed an antidepressant, to no effect. He went on medical leave from his job at an insurance company, withdrew to his basement and rarely ventured out.
“I became like a bear hibernating,” he said.
Missing the Intrigue
He looked for a psychiatrist who would provide talk therapy, write prescriptions if needed and accept his insurance. He found none. He settled on Dr. Levin, who persuaded him to get talk therapy from a psychologist and spent months adjusting a mix of medications that now includes different antidepressants and an antipsychotic. The man eventually returned to work and now goes out to movies and friends’ houses.
The man’s recovery has been gratifying for Dr. Levin, but the brevity of his appointments — like those of all of his patients — leaves him unfulfilled.
“I miss the mystery and intrigue of psychotherapy,” he said. “Now I feel like a good Volkswagen mechanic.”
“I’m good at it,” Dr. Levin went on, “but there’s not a lot to master in medications. It’s like ‘2001: A Space Odyssey,’ where you had Hal the supercomputer juxtaposed with the ape with the bone. I feel like I’m the ape with the bone now.”
The switch from talk therapy to medications has swept psychiatric practices and hospitals, leaving many older psychiatrists feeling unhappy and inadequate. A 2005 government survey found that just 11 percent of psychiatrists provided talk therapy to all patients, a share that had been falling for years and has most likely fallen more since. Psychiatric hospitals that once offered patients months of talk therapy now discharge them within days with only pills.
Friday, March 4, 2011
its not now a days that we scumb to monotony
it has had been with the living world through the entire history of human being
but what is with rest of world
Sciences point to a horrible fact
its something like as follows:
intellect as its often called as emotional quotient in modern day advance know how has got revolutionized on the heterogeneity basis. Well this heterogeneity basis is too enigmatic. A cruel fact is that Nature has empowered the female species to choose its bio-partner as de facto reality. In common language it means that the female has a choice of its own. This choice started from say 5 billion yrs ago. But this choice factor in bio sciences is not the "choice" as we understand today. The early stages of life choice meant to the level of mirco bio molecules itself. However the homogeneity has also played a part to the evolutionary part of choice but its contribution is far far less.
this further evolved to the macro-bio-molucles which we called basic single bio molecule which combine together to form one gene.
one gene is simple basic factor but the intricacy is not that simple. genes act on bio feed back mechanism. In common language we can understand if we start from say 1-100, any part say 25 or either 59 can trigger the formation of any number of sequences.
this makes the process of evolution highly complex scenario. What we are that's only 5% of the total genome with us. The remaining part is simply sleeping. The active part which produces wonders is only one percent.
Now this one % bio feed back mechanism is all what controls happiness and monotony: In other simple words monotony is present throughout the living world. Its %age varies through the bio-clock triggered gene physiological threshold of our nervous system.
my heart says : bullshit : tel me where is your one percent
I understand my heart but I simply say that my one % is simply sleeping
it simply makes no sense to my heart
is that non sense is a reality or say a better one
can't say
as its too too philosophical as sciences are concerned.
source: Neha.c.Mehta, shipra.v
FLOWERS OF RAJPATH..March..4,11.9.10 PM
its not now a days that we scumb to monotony
it has had been with the living world through the entire history of human being
but what is with rest of world
Sciences point to a horrible fact
its something like as follows:
intellect as its often called as emotional quotient in modern day advance know how has got revolutionized on the heterogeneity basis. Well this heterogeneity basis is too enigmatic. A cruel fact is that Nature has empowered the female species to choose its bio-partner as de facto reality. In common language it means that the female has a choice of its own. This choice started from say 5 billion yrs ago. But this choice factor in bio sciences is not the "choice" as we understand today. The early stages of life choice meant to the level of mirco bio molecules itself. However the homogeneity has also played a part to the evolutionary part of choice but its contribution is far far less.
this further evolved to the macro-bio-molucles which we called basic single bio molecule which combine together to form one gene.
one gene is simple basic factor but the intricacy is not that simple. genes act on bio feed back mechanism. In common language we can understand if we start from say 1-100, any part say 25 or either 59 can trigger the formation of any number of sequences.
this makes the process of evolution highly complex scenario. What we are that's only 5% of the total genome with us. The remaining part is simply sleeping. The active part which produces wonders is only one percent.
Now this one % bio feed back mechanism is all what controls happiness and monotony: In other simple words monotony is present throughout the living world. Its %age varies through the bio-clock triggered gene physiological threshold of our nervous system.
my heart says : bullshit : tel me where is your one percent
I understand my heart but I simply say that my one % is simply sleeping
it simply makes no sense to my heart
is that non sense is a reality or say a better one
can't say
as its too too philosophical as sciences are concerned.
source: Neha.c.Mehta, shipra.v
it has had been with the living world through the entire history of human being
but what is with rest of world
Sciences point to a horrible fact
its something like as follows:
intellect as its often called as emotional quotient in modern day advance know how has got revolutionized on the heterogeneity basis. Well this heterogeneity basis is too enigmatic. A cruel fact is that Nature has empowered the female species to choose its bio-partner as de facto reality. In common language it means that the female has a choice of its own. This choice started from say 5 billion yrs ago. But this choice factor in bio sciences is not the "choice" as we understand today. The early stages of life choice meant to the level of mirco bio molecules itself. However the homogeneity has also played a part to the evolutionary part of choice but its contribution is far far less.
this further evolved to the macro-bio-molucles which we called basic single bio molecule which combine together to form one gene.
one gene is simple basic factor but the intricacy is not that simple. genes act on bio feed back mechanism. In common language we can understand if we start from say 1-100, any part say 25 or either 59 can trigger the formation of any number of sequences.
this makes the process of evolution highly complex scenario. What we are that's only 5% of the total genome with us. The remaining part is simply sleeping. The active part which produces wonders is only one percent.
Now this one % bio feed back mechanism is all what controls happiness and monotony: In other simple words monotony is present throughout the living world. Its %age varies through the bio-clock triggered gene physiological threshold of our nervous system.
my heart says : bullshit : tel me where is your one percent
I understand my heart but I simply say that my one % is simply sleeping
it simply makes no sense to my heart
is that non sense is a reality or say a better one
can't say
as its too too philosophical as sciences are concerned.
source: Neha.c.Mehta, shipra.v
Wednesday, March 2, 2011
FLOWERS OF RAJPATH..March.2,11.6.26 AM
today is a religious day
but my religion is love only
my heart says then can you please tel me who is your love
I simply fail to understand what and how to reply to this spoilt child
At this moments probably you have just not awakened enough to realise that your love simply bypassed you
I will say nothing on reasons
I have stopped too too many times : my heart doesn't know the reasons
I knew from the very initial stage
system is horribly constrained by time factor
and my time simply runs at light's speed may be on plasmatic speed
I know you hardly understands poetry
it is something you yourself told me
I know you have forgotten your own version by this time
your time is definitely with you
but my time has simply fled on far beyond plasmatic speed
I know my this interpretation of my love will not make a sense
you are probably too naive at your own self
Any how you will remain at some of the wavelengths of my heart
but how far I have missed you
and realised that your simple existence has made me
what I never knew myself
and that's the reason
I don't expect you can understand me and my love
have a nice day
source: shipra .v
Tuesday, March 1, 2011
FLOWERS OF RAJPATH..March.1,11.7.59 PM
Today it was a different day
my boss came to me and said how r u Ahuja Sir: I said good morning sir: its fine with me: he replied how come you took leave on 24th ,(he knows I don't take leave as I have nothing to do except my office work). I replied nothin sir, some time normal dose of medicine doesn't work as I am surrounded by stupids all around and somehow double dose becomes super extra dose. He simply laughed as he understands the things around: Its fine take care and do tel me if I can do something for you:
I wondered how my technique worked so fast.
Today he worked like a real genius around. I was happy but my heart is a bullshit thin.
its a spoilt child: always looking for tophies say chocholate etc.
I can not bring its chocholates : I know this
but I knew I have won the game
challenges are simply nothing for me : I am too too used to it.
but my heart interrupted : hell !! with your prowess
I do realise its weakness
Nature never gives what you really deserve but nonetheless it gives you all instead which you hardly think of.
source : Neha c.Mehta
Monday, February 28, 2011
FLOWERS OF RAJPATH..Feb.28,11.4.58 AM
Today is a working day as usual
but I have not been awakened by the crunch of work
I'm too too tough nut at my work place
its simply impossible for any hardest environ of work equation that can make me sick
but I do become sick of my own making
I wish I could not have been so
some times I observe my Army officers
there is no need for me to ask any question to them
There's hardly anything which escapes me
I got refreshed by one of Neha c Mehta her own expression at her page only meant for herself
otherwise fighting every moment is just another meaning of me
I wished I could have put my wishes at her pages
my constrained nerve prevented me
there was something which prevented me for that intended wish
otherwise Neha c mehta is my favorite inspiration
one day , I know she will be put in such time frame whereby time will become obsolete
my time equations run too fast
but my heart asks too much
I simply say
I can not dare challenge time
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