Because psychiatry deals with non-measurable phenomenon -- even the serotonin theory of depression isn't chemically proved he writes -- it has over embraced the certitude of psychopharmacology to compensate, he says. But do psychiatrists, motivated by mysteries of the human mind and the desire to help people, really want to become mere "pill pushers" whose only contact with patients is 15 minute "med checks" as they hand patients off to less trained professionals for "therapy"?
"If I did therapy exclusively [as opposed to med checks] I would have to take a 40-50 percent pay cut," Carlat admits in one of many passages that show he is not exempt from the criticism he levels. In fact, many first heard of Carlat in 2007 when his article about promoting the antidepressant Effexor for Wyeth (now Pfizer) for a year, called Dr. Drug Rep, ran in the New York Times magazine.
In an interview, Carlat told me he got less "pushback" from that article than one that ran in the magazine in April called Mind over Meds that provoked another psychiatrist at the American Psychiatric Association (APA) meeting last month to attack him.
"Mina Dulcan, MD [Chair of Child Psychiatry at Northwestern Medical School] was signing textbooks and when I introduced myself she said, 'How dare you write in the New York Times that your therapy training at Mass General was terrible, and that you had a so-called great awakening,'" Carlat told me. "How are you any different from the drug companies, writing your article to sell your book and newsletters? What a disservice you have done to psychiatry!'"
Carlat publishes the Carlat Psychiatry Report, a monthly CME newsletter and the Carlat Ch ild Psychiatry Report edited by Caroline Fisher, MD from the University of Massachusetts Medical School, Worcester.
And there has been other fallout, says Carlat. He voluntarily resigned his elected seat as Massachusetts representative to the APA Assembly, a governing body, upon publishing Unhinged.
"In Unhinged, I support the idea of psychologists prescribing medicine and the development of a new training program that would be a hybrid between medical school and psychology graduate school," Carlat told me. "Even though I was asked to stay on as representative, I didn't want to put my colleagues in uncomfortable positions."
Why would changing psychiatric training and even who prescribes meds make colleagues uncomfortable?
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