Speaking Of Paradigm Shifts

Spurred by a news account, I noted yesterday that the world of psychotherapy and, to a lesser degree, psychology has, over the last generation, shifted away from being dominated by classic psychoanalysis to being the province of cognitive behavioral therapy. That shift, of course, has all kinds of implications for the ivory tower crowd, but in the regular world it's not nearly as meaningful as academics would like it to be. That's because most psych patients get their care through psychiatrists and GPs and take psychotropic medications, a paradigm shift that supplanted the psychotherapy-alone paradigm in the late-1980s. By far, that is the dominant paradigm in treating mental illness and bad feeling and behavior in American society. Why? That's the way Pharma companies, mental health advocates, policy makers and insurers want things to be. It's the consenus in charge, you might say. Patients, by and large, have little ability to go against this flow unless they happen to be rich, well-insured and can pay for psychotherapy out-of-pocket. So chit-chat about what's up and what's down in the world of psychology has very little bearing on how patients actually get their care.

The sad thing is I can't find any evidence that shifting from psychotherapy-alone to biological-based treatments has improved the game for patients with the kind of global impact that proponents of the psychopharmacological revolution claim.

So how does that make you feel?