“Drowned in a Stream of Prescriptions” (NYTimes, 2/3/13): Commentary on Richard Fee’s Adderall addiction

In the New York Times Sunday Edition, (2/3/13), a long article featured the tragic story of Richard Fee’s Adderall addiction starting while he was in college, and told of the repeated improper prescription of stimulants, and the inadequate psychiatric care leading up to his death. This very tragic story is unfortunately indicative of problems that go far beyond the widespread prescription of stimulant medication and the abuse of these drugs.

In fact, this same story could have been about any psychoactive drug, psychiatric disorder, prescriber or patient, for the story is indicative of the current state of psychiatric practice in the US today. Diagnoses are often made after a single interview, during which the patient may fill in a standardized form of symptoms. Medication is often immediately prescribed, with the ongoing treatment consisting of infrequent visits for medicine check-ups. These visits, usually between five to fifteen minutes, are too short for the subtle effects of the medications to be observed by the provider on the patient’s thinking, shifting mood states, pre-occupations, fantasies or the details of their day to day life functioning. Instead the prescriber must rely on the quick self reported response of the patient, who often will then be given another three to six months worth of prescriptions at that time.

While there have been major advances in psychoactive substances that are proven to help human suffering, and while much more is known about the brain mechanisms involved in some disorders, these advances alone do not account for the nature of psychiatric treatment today. It is market place concerns not sound scientific principles that have hijacked the field of psychiatry. Pharmaceutical companies not only send their representatives to physicians’ offices to educate them of the latest products, they come laden with gifts, food for the staff, free samples to be given to patients and invitations to dinners at the most expensive restaurants in town in the guise of professional “round-table discussions”. They also entertain young psychiatric trainees, take them to restaurants, pay for their fares to professional meetings, and barrage them with information about their products. Pharmaceutical companies under-write professional meetings, research, some psychiatric publications and flood psychiatrists’ mail with advertising materials, while they make wild promises for their products in the public media.

In addition, the profit driven health insurance industry has become unwilling to pay for the high standard of care that previously existed in the psychiatric profession. As seen in the article in the Times, much needed hospital stays are cut short, while inadequate reimbursements for thorough assessments and careful follow up have led providers to abbreviate their contact with patients. Insurers generally insist that “medically necessary” treatment for most diagnoses is medication.

The careful listening and thorough investigation needed for diagnosis, the close follow-up and concomitant therapy that is needed by all patients taking psycho-active medication and the in-depth understanding and healing of a person’s psychological distress that can be achieved by in-depth psychotherapy are no longer supported by the market place that controls psychiatric care in this country. A profound understanding of human suffering, the very foundation of our field, is no longer valued or paid for.

This is a tragedy for all.

Josephine Wright