Re-Evaluating the Evolving Role of Psychiatry

I have been licensed as a medical doctor in the state of California since 1962 and have been in the practice of adult psychiatry and psychoanalysis since 1965.

The article (“High Anxiety: Psychiatrists See Drop in Status as Roles Shift,” June 18), presents a dismal picture of what is emerging for those of us in the practice of adult psychiatry and what future psychiatrists might anticipate. It also is upsetting for our patients to imagine that future generations may not be able to visit with a psychiatrist.

A physician starts medical school when he or she is 22 years of age and is introduced to the doctor-patient relationship with a “hands-on” approach. For those specializing in psychiatry, a three-year psychiatric residency follows graduation from medical school. An additional seven years of training is then required to become a psychoanalyst.

There is no doubt that other mental health professionals have the ability and training to understand the mind and body and can deliver empathic therapeutic experiences to their patients. However, the training brought by mental health physicians to their work with patients is unique.

While mental illness is epidemic in our country and the world, too little is done to alleviate the suffering it causes.

I believe that psychiatrists will continue to be present and valued as we seek to contribute to the mental health of individuals.

ARNOLD L. GILBERG

Beverly Hills

Gilberg is a past president of the Southern California Psychoanalytic Institute.

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The psychiatric industry is a dying breed because they have never been able to cure anyone with their “treatments.” Drugs, electric shock and brain operations have never cured anyone. It has created zombies, addicted and violent people. Drugging individuals with drugs that paralyze their nerves and keeping them warehoused in zombie-type states of existence in psychiatric hospitals is not a cure for the problems and the stresses of life. That is not rehabilitation.

If you can’t give people a good product or service for their hard-earned money, they will not want your product or service. This is what is happening to the psychiatric industry. When was the last time you saw the services of a phlebotomist (bloodletter) in the Yellow Pages? Psychiatry is going the same route as phlebotomy.

ART STEIN

Los Angeles

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As a psychiatrist in a prepaid group practice, I read with interest your article which describes the “eroding” and “narrowing” of psychiatric practice to diagnosis and treatment with medications.

I object to the dichotomy presented of talking versus prescribing. As a psychopharmacologist, I do diagnostic evaluations, care for patients in collaboration with other mental health professionals and provide consultation to physician colleagues. My work always involves skilled interviewing, discussion and teaching with patients. I do not feel my role is “reduced” as described in your feature. Instead, it is quite challenging and rewarding to assist persons plagued with depression, panic or other psychological symptoms in a context where I cannot provide years of psychotherapy.

All physicians have an obligation to be conscious of utilization of resources. My own time and resources are used in an efficient manner which I believe does not shortchange my patients. As for Dr. Wolfe’s statement that “prescribing medications is not why we go into the specialty,” this is equally true in any field of medicine. Writing a prescription is only the end point in a complex process of human interaction.

LORETTA HOWITT

Los Angeles

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You made several references to clinical sociologists , but there is no such discipline in mental health. Sociologists conduct research on groups and are not trained to diagnose and/or treat mental illnesses.

Perhaps you are confusing clinical social workers with sociologists. According to the Department of Health and Human Services, clinical social workers provide 62% of all mental health services in the United States.

GEORGE ANDERSON

Los Angeles

Anderson is director of Psychological Services for Adults.