Therapy as the Central Focus of Psychiatric Treatment

It is rare that psychiatric research makes the headlines two weeks in a row. The current news discusses the results of a large study on schizophrenia, which, along with anorexia, have the two highest mortality rate of any psychiatric illness. 

The study reports that low dose medications plus regular psychotherapy is more effective than high dose medication alone. 

This is shocking news because psychiatry has hung its hat on medications as the best form of treatment for this illness with hope for more thorough pharmacological cures in the future. The NIMH funded study has clearly proven otherwise. 

Psychiatry has worked hard to find a place in the scientific world by relying on brain science and medications as the best hope for the future. Our limited understanding of the brain may be the reason this supposition is unrealistic. Perhaps it's a matter of time before brain science leads to simple pharmacological cures.

But there is also the possibility that the complexity of our brain doesn't lend itself to quick fixes. So much of our miraculous central nervous system is attuned to interaction with the environment, especially other people. Psychotherapy, a treatment that grew out of, at least in part, the lack of other viable alternatives, may be grounded in something very real and, at its core, scientific.  

In other words, the most potent tool to change brain function may be relationships themselves. 

This new study about schizophrenia and last week's conclusion about eating disorder behaviors as habits have one key similarity. Brain behavioral patterns, once established, are ingrained and difficult to change. Repeatedly research studies have shown that therapy is as effective or more effective than medications for almost all psychiatric illnesses: schizophrenia, eating disorders, depression and anxiety disorders. 

It's a novel idea to approach psychiatric treatment with the expectation that establishing effective, meaningful relationships is at the root of change with medications as an important but secondary tool. Although medication may play a role, relying solely on pharmacology does not have a good track record. 

Heeding the recent news means focusing on the therapy relationship first and foremost as the step into wellness.