In the old days in American psychiatry nearly everybody was thought to be a little bit schizophrenic. Under the influence of such writers as Harry Stack Sullivan the shades of possibilities for schizophrenia were all-inclusive. While this is a serious psychiatric disorder that involves incongruous thoughts and emotions that are often very peculiar, even the slightest symptoms of distress were considered to be schizophrenic in nature. The current craze (pun intended) is to think that everybody is a little bit bipolar.
Many people have sudden changes in mood from being somewhat or very depressed to being happy or giddy and euphoric. In other cases people are quiet and calm and suddenly blow up, supposedly for no reason. When somebody acted in a way that we didn't understand or couldn't tolerate, it was very easy to label them as abnormal. Nowadays we, the public, go further—we label them “Bipolar.”
With all the television programs that we see almost every day on FX, lifetime, Opera, Dr. Phil and other stations, we've all become experts in psychiatry. Not only do we have the problems of celebrities and historical figures put forward for our analysis, but we're also asked to diagnose ourselves. Who among us hasn't seen the ads for Cymbalta, Zoloft and Abilify? The drug companies expect us to see ourselves in their ads and to go to the family doctor and ask for the medicine in question. This way, too often, people are put on medicines that may or may not be appropriate for their condition.
Some good can come from the current practices. At some point in their lives 15 to 25% of Americans suffer from a major depressive episode (commonly known as clinical depression). It has probably improved many lives for people to go down to their family physician and ask to be put on Prozac, Celexa, Lexapro or Zoloft. These medicines are very safe: the risk of severe side effects or any major difficulties is small. They are effective for mild, moderate and even major depression. They probably also improve minor symptoms of dysphoria and stress. Thus it is very comfortable for doctors to prescribe them without doing a thorough psychiatric evaluation. In many cases the patients get better in some way and the doctor is confirmed in his or her expertise. However, for some bipolar patients, antidepressants may actually add to their problems by triggering a manic episode.
A different challenge for psychiatrists is to discriminate between those who have a mood disorder that will respond to treatment and those who have personality traits that are enduring and unchangeable. While other mental health professionals, including psychologists, social workers, marriage and family counselors and pastoral counselors all have opinions of medications and when they are necessary, the psychiatrist may be in the best position to assess the underlying psychiatric disorder and determine the appropriate treatment.
In my own practice I found that not everyone needs medication. Many problems can be addressed by talking therapy, which I provide in any case. Other patients come to me when medications are causing side effects and want to know what their other options are. My working philosophy is that everyone should receive the maximum benefit with the fewest possible side effects. If any medication is causing side effects, there are many other options among which a best choice may be made.
