The “Dose of the Doctor” Matters
This is a good time for American psychiatry. After nearly a quarter century of a reductionistic focus on biology and medications as mutative factors in mental health, psychiatry is rediscovering what it had already known. New studies are regularly demonstrating the crucial importance of psychosocial factors in the treatment of a range of mental conditions.
It is now clearer than ever that psychiatry must be biopsychosocially integrative if it is to be effective. Several months ago the RAISE study showed that patients with first episode schizophrenia do substantially better if a psychosocial component is added to drug therapy for this disorder. Most recently, Buckley and colleagues (Buckley, et al, 2016), in a study designed to assess the effectiveness of oral antipsychotics versus injectable antipsychotics, found something other than what they were looking for. The patients with schizophrenia in their study had surprisingly low relapse rates, whatever form of medication they used. The conclusion was that the most important thing may, in fact, not be the dosing of the medication, but rather the dose of the doctor (see Mintz and Flynn, 2012, p.153).
This reminds us of what psychoanalyst Michael Balint (who gave us the concept of patient-centeredness) observed over half century ago in his study of treatment-resistant patients when he said "the doctor is the drug.”
- Psychological Factors Play a Significant Role in the Outcome of Psychopharmacological Treatments
- Why don’t psychiatrists do psychotherapy even though it works?
- Dr. Mintz points to more evidence that psychological factors shape response to meds
- Psychodynamic Psychopharmacology
- The Doctor-Patient Relationship and Medication
- A Novel Approach to Medication Management at Austen Riggs