You’re no longer likely to find a couch in your psychiatrist’s office. That’s because there’s no need for it anymore. Most psychiatrists no longer provide talk therapy. A government survey from 2005 suggests that only 11 percent of psychiatrists actually provide the service, and that number has surely dwindled since.

That’s not to say that psychiatrists are no longer providing services. After an initial 45-minute evaluation, most psychiatrists will prescribe medication and send the patient on his way. In a few months, the patient will come back in for a 15-minute check-up. Though by that time, the psychiatrist will often have forgotten the patient’s symptoms or even his name. Psychiatrists still work with the mind, but now they transfer that work to medicine. Ironically, these shifts in psychiatry direct the attention away from the patient, the person who is supposed to be of the utmost importance in this practice.

The reasons for this are myriad but are largely related to insurance. Most insurance companies simply will not pay the fees psychiatrists were long accustomed to charging. As a result, psychiatrists — many still paying off student loans — had to find other ways to make a profit. They turned to an approach that yields a high number of patients and also relies on writing medications. Though this isn’t what many psychiatrists had in mind when they entered the field, for the most part, their business is no longer a deeply personal one.

The key here is money. Psychiatrists had to tweak their practice in order to stay financially viable. In effect, they chose profit over patient. This is not to label all psychiatrists as greedy or callous — the amount of education they must pursue in order to become doctors shows a level of dedication that prohibits such dismissive labeling. But it’s important to note that psychiatry is no longer a business interested in forming relationships. Due to large patient volume, psychiatrists often have to remind their patients that they aren’t their therapists.

While it’s true that psychiatry — like any medicine, is a business — it’s also a field that deals with a very personal and potentially powerful organ: the mind. As such, the importance of profitability over patient care seems especially sinister.

And this response ignores the most important part of the process — the patient. After all, when a patient visits a psychiatrist’s office, he’s often in some sort of serious distress. Maybe it’s depression or anxiety. Maybe he’s lonely. It often takes a long time for such a state to develop. Take depression, for instance. You don’t become depressed overnight. It’s an illness that takes a long time to develop. The converse is true, too: Depression doesn’t disappear overnight. Prescribing medications without any long-term follow-up is evading the real problem. In a psychologist’s office, on the other hand, without the crux medicine often provides, patients are forced to actually work out their issues.

But how does the patient feel about this? The question can’t be answered without considering another one: What does the patient hope to get from psychiatry? Happiness? The ability to thrive once more? Or does the patient simply hope to function again? As it stands, psychiatry seems to answer the last question. And this seems like a pretty low expectation, especially when you consider just how powerful medication can be — in some cases, it can create imbalance, side effects or dependency (though for many, the medications do succeed in pulling the patient’s mind back to a functioning, healthy level). Psychiatrists often attempt to direct their patients to therapy via a psychologist or therapist, but few patients follow through. The drugs are a quick fix, and many patients would rather not spend the additional money on seeing a psychologist or therapist.

This shift in psychiatry asks for a tremendous amount of trust from patients without much accountability on the psychiatrist’s side. Because psychiatrists are burdened with such a high number of patients, it’s hard for them to remember names, let alone symptoms or life stories. Though psychiatrists may be important figures in many patients’ lives, that relationship can no longer transfer to the psychiatrist. It’s hard to build a relationship with someone you only see once every few months for 15-minute intervals. Multiply that by a thousand people and you’ll see what sort of odds the psychiatrist is working with.

In directing their patients toward medication, psychiatrists give up any personal stake in the patient’s well-being. If the medication works, that’s great. But if it doesn’t, it certainly won’t devastate the psychiatrist.

Mary Demery can be reached at

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