The Mental Health Profession is Failing

We do best not to seek out deeper meanings in two high profile suicides. We do not know what medication Kate Spade was taking and how it influenced her actions. And we know very little about Anthony Bourdain’s suicide. We do not even know whether it was intentional or accidental and whether he left a note. We probably will never know.

Throughout my own comments on the issue of suicide I have tried to draw attention to the fact that a wave of suicides, coupled with a wave of depression and anomie, tells us that our mental health system is broken. It also tells us that our culture is broken.

Today, Benedict Carey argues these points at length in an important New York Times column:

The escalating suicide rate is a profound indictment of the country’s mental health system. Most people who kill themselves have identifiable psychiatric symptoms, even if they never get an official diagnosis.

The rise in suicide rates has coincided over the past two decades with a vast increase in the number of Americans given a diagnosis of depression or anxiety, and treated with medication.

The number of people taking an open-ended prescription for an antidepressant is at a historic high. More than 15 million Americans have been on the drugs for more than five years, a rate that has more than tripled since 2000.

But if treatment is so helpful, why hasn’t its expansion halted or reversed suicide trends?

As noted before, today’s antidepressants do possess a notable suicidal ideation risk. And, we also know, SSRIs disinhibit…. Actions you might be too afraid to take might become easier to commit when your medication has suppressed your fears.

But, what role does psychotherapy play in all this. Surely, it is widely available. But, how effective is it? How many people who suffer depression consult with therapists? How many of them prefer to pick up a prescription from their local internist?

Carey introduces statistics from Denmark:

But one recent study, by Danish researchers, supported the benefits of therapeutic intervention.

Using detailed medical records, the investigators studied more than 5,500 people who had been treated for deliberate self-harm, including cutting and clear suicide attempts.

Over decades, the portion of those people who got psychotherapy at suicide clinics were about 30 percent less likely to die or commit further self-harm than those who did not.

“I personally think that it’s the quality of care that matters, not the quantity,” Dr. Insel said. “We need more access, better measures and better quality of care.”

But in this country, many of those who commit suicide have received little or no professional help. Indeed, they rarely tell anyone beforehand of their plan — when there is one. Often the act is impulsive.

Since we do not live in Denmark and do not know how that therapy is practiced there, comparisons are difficult to make. 

When it comes to America, we must notice, as I have often said, that far too much American therapy is of the touchy feely variety. Patients are induced to get in touch with their feelings and to feel their feelings. Beyond the fact that this approach doubles down on the social disconnection these patients feel, there is very little chance that the average middle-aged male, belonging to a high risk population, is going to consult with a therapist who is going to mother him or is going to tell him to get in touch with his feminine side.

One can question how effective this approach is for women. Most likely, not very. The more therapy becomes a woman’s profession, the more people seem disinclined to consult. Or disinclined to take it seriously. If therapy is just offering professional mothering, why would anyone undergo the process? If therapists can do nothing more than to send you scurrying into your soul to dredge up repressed feelings, why bother? If therapists’ go-to solution is to drown every problem in empathy… what’s the point?

For people who are suicidal, the prospect of receiving empathy from a female therapist is not going to be too appealing. It's going to feel offensive. Especially for men, but likely also for women.

To be clear, I am talking about the public perception of therapy, not necessarily what your neighborhood therapist is doing. Surely, cognitive therapists are far more effective in treating depressed suicidal patients… but how much of it is really available. And how many people know the difference between touchy feely and cognitive therapies?