Psychiatry and Psychotherapy: 1 Out of 3 Could Benefit
At some point, one out of every three Americans suffers a mental disorder serious enough to benefit from treatment. Unfortunately, among those who need therapy, only 20 to 25 percent of adults and 60 percent of children undergo it. Why is mental illness so neglected? Experts note that even in this enlightened age, it still carries a social stigma, and large numbers of people who could be helped elect to suffer in silence. Others try to heal themselves, often with little or no success. Still others recognize that they have a problem, but don't know where to go for help, or cannot afford the usually high cost of therapy.
An Expanding Field
At one time, psychiatry dealt mostly with severe and incapacitating menial illness. Today, psychiatrists and other mental health professionals are called upon to treat a wide range of problems: eating disorders, sexual dysfunction, marital problems, stress-related diseases, personality problems, violent and aggressive behavior, alcoholism and substance abuse, and sleep disorders, among others. As with other medical specialties, medical health professionals tend to concentrate on one or two areas; it might be family therapy, for example, child psychiatry, or treatment of mood disorders.
Treatment of menial illness has changed dramatically since the 1950s, when psychoactive drugs were first introduced. Before, patients with severe mental illness were institutionalized. Now potent tranquilizers and other drugs enable them to live independently, or at least outside of a menial hospital. Although millions of people have been helped by these new drugs, there are drawbacks. For the most part, they do not cure, but instead help to bring the disease under control -- a process that usually requires continuing therapy. In treating manic-depression and schizophrenia, for example, life-long drug therapy is necessary, usually in conjunction with counseling.
Persons undergoing this combined approach can often lead productive, relatively normal lives, especially in group homes or similar settings. Too often, however, they are left on their own and may relapse after stopping medication. Mental health experts estimate thai up to one-third of the homeless people in U.S. cities are patients who would have been institutionalized in the past.
Side effects of psychoactive drugs pose other hazards, which range from drowsiness and movement disorders to addiction and fatal overdoses. Finding the right dosage or combination of drugs to minimize such effects can be costly and time-consuming. And psychoactive drugs must always be used under close medical supervision.
Even if psychoactive drugs are prescribed, non-drug therapy is also recommended. The type of approach varies according to the underlying illness, and may include the following:
Psychodynamic psychotherapy attempts to uncover the source of mental disturbance by having the patient talk freely, especially about childhood experiences and dreams. In its classic Freudian form, it is conducted individually, with the patient talking while the therapist listens. One-on-one psychoanalysis is the most intensive, lengthy, and expensive form of psychotherapy, requiring from one to five sessions a week for three to five years. Variations on this approach include group, couple, or family therapy, in which a therapist treats more than one patient simultaneously.
Short or time-limited psychotherapy has evolved as a popular alternative to classic psychotherapy. In this approach, the patient and therapist agree upon a specific goal and the number of sessions needed to achieve it.
Cognitive therapy, which is also a short-term treatment, seeks to identify and correct distorted thought processes that result in self-defeating behavior. For example, if you are invariably late in meeting assignments because you cannot get started before a deadline looms, the therapist will help pinpoint the attitudes responsible for your poor work habits, and suggest ways to change them. This approach is especially effective in treating depression.
Behavior modification focuses on correcting a faulty habit or behavior without addressing any of the underlying psychological aspects. It is especially helpful in overcoming phobias, bad habits such as smoking, eating disorders, and certain compulsive behavior such as obsessive hand-washing.
Electroconvulsive therapy (ECT) is a controversial and much misunderstood treatment for severe mental illness. During this process, pulses of electrical current are administered to the brain, producing brief seizures. Doctors do not fully understand how it works, but ECT remains one of the most effective treatments for severe suicidal depression. It is also recommended for psychotic or depressed elderly patients who cannot tolerate any kind of drug therapy. ECT produces results much faster than antidepressant drugs. There is temporary memory loss, but otherwise, the procedure is relatively safe. And, contrary to popular belief, it is not painful. In fact, the patient does not feel the current and experiences only minor finger or toe movements. Typically, a patient is drowsy or confused for an hour after treatment, although memory loss or difficulty in learning new material may persist for several weeks.