“Nowadays, people don’t ‘go into therapy’…they ‘receive mental health interventions,’” writes Enrico Gnaulati in a cynical introduction to his new book Saving Talk Therapy: How Health Insurers, Big Pharma, and Slanted Science are Ruining Good Mental Health Care.
Years ago, people viewed therapy as a place where they would go to share some of their deepest thoughts and have open ended discussions about their feelings. Therapists had more freedom to work with clients to resolve an issue without an agenda or pre-defined number of sessions.
The release of Prozac in 1987 impacted the practice of therapy. With this “miracle cure” and with health insurance companies jumping on the short-term treatment bandwagon, talk therapy began to go by the wayside. As cousins of Prozac such as Zoloft and Paxil entered the market, the theory of depression as a chemical imbalance took root, further encouraging a pill rather than a process.
Understandably, a “quick-fix” with a pill appealed to insurers. A chemical imbalance is treatable with medication whereas traditional therapy is a longer-term solution. Clearly medication, especially generic medication, is a more appealing option for insurance companies because it’s cheaper.
Gnaulati points his finger at the pharmaceutical companies, who quickly learned that they didn’t even need to talk to the doctors to sell their products. Through TV and magazine ads, these companies could talk directly to patients with commercials that instructed them to “ask your doctor if this medication is right for you.” Should laypeople without medical training really be the ones to tell doctors what medication they want to be on?
“By 2007, Americans were being exposed to as many as sixteen hours of prescription drug television advertisements annually, according to a study spearheaded by Dominick Frosch in the Department of Medicine at UCLA,” writes Gnaulati. Ten years later, I imagine that number is significantly higher, providing further reinforcement that medication is the answer.
What also changed our perspective of mental health treatment is that a psychiatrist is no longer needed for psychiatric medications. Much is prescribed by other doctors, whether it’s a primary care doctor or a gynecologist. Since medications are at times viewed as a cure-all that negate the need for therapy, psychiatric treatment is no longer in the hands of the psychiatrist.
Gnaulati does not completely negate the need for medication in some cases. Symptom management is a laudable goal in mental health treatment, especially when those symptoms prevent people from living a productive life, doing well at their jobs, or getting sleep at night. But people want more in their lives than symptom management.
“Narrowing the criteria for recovery to very specific, changeable thoughts or behaviors to be eliminated might make for tidy research, but most depressed people in therapy don’t judge their progress in terms of having fewer pessimistic thoughts,” writes Gnaulati.
Saving Talk Therapy is appropriate for several audiences. First, the student working on a degree with the intent of practicing therapy one day. Not to dispel any starry-eyed notions of processing the human experience leisurely over unlimited sessions as long as the client needs it, students can be made aware of the challenges they’ll experience if they choose to get on insurance panels. Students should know what they’re up against before they graduate and understand, too, that patient perceptions of the value of therapy has shifted.
This would also be a good book for anybody who is making policy decisions about health insurance. Many people end up in their primary care doctor’s office with what are really mental health complaints. That’s not new information. But there’s something wrong with the treatment available to consumers today. Perhaps this book can help shift thinking about our approach to mental health.
Another segment of readers may appreciate the sections on medication. Whether it’s taken for a mental health reason or another concern, patients need to know that drug companies don’t always have the best interest of the patient in mind. Awareness that the messages about pharmaceuticals may not be what they actually experience helps patients become educated about what they choose to take, or not take.
To summarize Saving Talk Therapy, there’s no better way to do so than using words directly from the author:
“We live in an age where the over-reach of big Pharma, extravagant expectations placed on medications, the underfunding of psychotherapy by health insurers, in the oversupply of brief, problem-solving therapy supported by slanted science all plays traditional talk therapy in jeopardy. Now more than ever there needs to be renewed focus among mental health educators, researchers, professionals, and other advocates to preserve humanistically informed and scientifically backed traditional talk therapy,” writes Gnaulati.
Saving Talk Therapy: How Health Insurers, Big Pharma, and Slanted Science are Ruining Good Mental Health Care
Enrico Gnaulati
Beacon Press
January 2018
Hardcover, 264 pages
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