The front page article in the Sunday review section of the Times today is by Peter Kramer, of “Listening to Prozac” fame, a fellow Brunonian, (the attention doctor was Class of ’76). He’s one of us aging prescriber therapists; but I’d be surprised if you can use ObamaCare to get in to see him.

He pitches his article as a plea for the value of storytelling as a means of teaching the essentially currently un-researchable combined skills of prescribing and conversing therapeutically. What he really does, in the very mild mannered way that polite academic psychiatrists do, is to reveal the bankrupt, corrupt, useless self serving nature of “research psychiatry” and the “evidence based” CBT (cognitive behavioral therapy) which the medical schools, insurance companies and the government are currently using to suck the life out of therapy and the money away from providing mental health care or training.

The sad ugly truth is that there are only two funding sources for psych research: Uncle Sam, ever altering priorities blown by the wind of the next election, and the drug companies, whose research methods are more profit driven and distorted than even the most cynical of us would dare to believe. Neither results in lots of useful truth.

Studies are generally short and unsubtle, driven by the economics of finding and keeping patients willing to distort their care for arguable gain and by the comic “exclusion criteria” designed to purify the studies enough to be meaningful. They just aren’t. Meaningful that is.

I think the real point of Kramer’s plea, unspoken if you ask me, is that what is needed is the integration of therapy with prescribing, that doctors spend enough time with patients that they actually “could” tell a story, that doctor and patient know each other, and that this relationship, this knowledge of each other, really, as persons, is what needs to be taught and supported and continued, and is very, very much a part of the experience that in fact changes the brain.

Not too much of that going on out there now is there?

Izzat right, Pete?

Stay tuned ladies and gentlemen; if you like us tell your friends.

More to come.

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