Band Wagons or "the latest treatment"

It is reasonable to fear psychiatrists that just prescribe medications and those that won't. Patients deserve to be treated for what works best rather than a psychiatrists therapeutic preference. A recent article in the American Journal of Psychiatry talked about Benjamin Rush, the father of American psychiatry. Dr. Rush was the only physician to sign the declaration of Independence and also the Constitution. He was a great doctor and a great American. During the Yellow Fever epidemic in Philadelphia, Dr. Rush stayed behind to save people's lives. Unfortunately, his primary treatment was a common one of that time called blood-letting. Even though this treatment was ultimately ineffective, Dr. Rush prescribed it even for himself. He survived thankfully although it reinforced his conviction. The point of this story is that after WWII, psychiatry believed that psychoanalysis was the treatment for everything. In the 1950's, we started to prescribe effective medications for many psychiatric maladies. The biological psychiatry revolution has been truly helpful for many patients. Unfortunately, many medications are only effective with some kind of talking therapy. At present, many neuro-scientists are using Freudian insights to guide their biological and genetic investigations. As one of my insightful psychiatry colleagues has admonished, "for all the psychiatrists who proudly proclaim they don't so psychotherapy, shame on you. For all the psychiatrists that proudly proclaim they only do psychotherapy and never prescribe pills, shame on you." Thankfully, most of us do both psychotherapy and medication management or at least insist that patients on medication need the addition of psychotherapy. Band-wagons could be a reasonable perspective for researchers as they need to focus and pursue their ideas with passion. Clinicians need to provide the people who are desperate for help the best treatments available, not what they have the most training in, or their "favorite approach." I get excited about new treatments and always hope they'll work. The ideal care however, is guided by science and at the same time open minded. That is certainly the case in psychiatry and psychology when all the answers are still not in. We know a tremendous amount when it comes to people, although we still have lots to learn, as in every branch of medicine. If you think otherwise or agree, let us know.