Patient's name: Psychiatry.
Age: In middle years.
History: European born. After sickly youth in the U.S., traveled to Vienna and returned as Dr. Freud's Wunderkind. Amazing social success for one so young. Strong influence on such older associates as Education, Government, Child Rearing and the Arts, and a few raffish friends like Advertising and Criminology.
Complaint: Speaks of overwork, loss of confidence and inability to get provable results. Hears conflicting inner voices and insists that former friends are laughing behind his back. Patient agrees with Norman Mailer: "It's hard to get to the top in America, but it's even harder to stay there."
Diagnosis: Standard conflictual anxiety and maturational variations, complicated by acute depression. Identity crisis accompanied by compensatory delusions of grandeur and a declining ability to cope. Patient averse to the therapeutic alliance and shows incipient overreliance on drugs.
Recommended treatment: Requires further study.
Prognosis: Problematic.
Each day millions of Americans talk, scream, confront, jump, paint, dance, strip, tickle and grope their way toward emotional fulfillment. They are sampling one or more of the 200 or so therapies and countless pseudo therapies that are now being peddled in the U.S. as panaceas for unhappiness, anxiety or worse. At one end of this therapeutic spectrum are such exuberant exercises in self-help as biofeedback and Transcendental Meditation; at the other end, close-order drill for the psyche, like est. All but trampled by this stampede toward satisfaction lies the battered body of the medical specialty that once held the exclusive franchise for curing all maladies of the mind. Obviously it no longer does—one reason why psychiatry itself is now on the couch.
The symptoms of psychiatry's ills are apparent enough. The U.S. has 27,000 psychiatrists in active practice, up from 5,800 in 1950. But now the bloom is off the therapeutic rose. Today only 4% to 5% of medical school graduates go into psychiatry, vs. 12% in 1970. Says one doctor: "Psychiatry is not where the action is."
Indeed, on every front, psychiatry seems to be on the defensive. Private groups with names like Alliance for the Mentally Ill are beginning to batter the profession and its hospitals with the same kind of malpractice suits that plague the rest of medicine. Many psychiatrists want to abandon treatment of ordinary, everyday neurotics ("the worried well") to psychologists and the amateur Pop therapists. After all, does it take a hard-won M.D. degree (a prerequisite psychologists do not need) to chat sympathetically and tell a patient you're-much-too-hard-on-yourself? And if psychiatry is a medical treatment, why can its practitioners not provide measurable scientific results like those obtained by other doctors?