PSYCHIATRIC OPINIONS IN THE DAILY NEWS The Sunday New York Times story with her photo was “This Teen Was Prescribed 10 Psychiatric Drugs. She’s not alone.”1 No, she’s not, but it’s not a simple over-prescription story, as this and the accompanying story imply. Yes, there is that, but if we look deeper, as we often can and should, there is something else driving such scenarios. As business began to take over psychiatry and the rest of medicine in the 1980s, the role of psychiatrists was increasingly limited to being prescribers with brief assessments and brief follow-up medication visits, rather than doing more psychotherapy such as dialectical behavioral therapy (DBT ) with or without medication.2 Care management has done this by controlling reimbursement and mandated patient time, leading to large profits, and most recently the mental health worker strike at Kaiser Northern California.3 Resources, such as the limited number of good housing facilities, are often not covered by insurance. In addition, mental disorders have been increasing among teenagers in recent years, especially after the pandemic. It’s no wonder, then, that child and adolescent psychiatrists—always in short supply—became increasingly reliant on medication, especially when suicide seemed to be a risk, as was the case with this teenager. Fortunately, this teen eventually found a psychiatrist who spent more time with her and simplified her medication. It is not clear whether this psychiatrist was unusually concerned or some insurance coverage less controlling. Fortunately, also, and perhaps a major cause in the ineffectiveness of the previous medication, was the thyroid problem that was diagnosed almost a year ago. Her thyroid cancer was apparently cured by surgery last April. Although psychiatrists are uniquely trained to look for medical causes of psychiatric symptoms like this, this usually takes a thorough evaluation with plenty of time. Later on Sunday, my wife and I saw Shakespeare’s famous play Hamlet. Hamlet appears to be a teenager or young adult. Agonizing over his father’s murder, he utters the famous monologue “to be or not to be…” One interpretation is that he had killed himself at the time. As it turns out, his girlfriend Ophelia kills herself after rejecting him and kills her father. Then he dies, as others do, at the end in a kind of murder/suicide. Although they performed this play in modern dress and speech, there were no psychiatrists in Shakespeare’s time. If there was, perhaps psychiatry could have saved Hamlet and helped him find an alternative to his traumatic loss, if we had better systems that provide the environment for us to heal as much as we can and not burn out in the process of trying to better anyway. Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific author and speaker, he was named a Hero of Public Psychiatry by the American Psychiatric Association Convention in 2002. He advocates for a better world on mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism. He serves on the Editorial Board of Psychiatric Times™. Report

  1. Richtel M. This teenager was prescribed 10 psychiatric medications. She is not alone. The New York Times. August 27, 2022. Accessed August 29, 2022. https://www.nytimes.com/2022/08/27/health/teens-psychiatric-drugs.html
  2. Moffic HS. The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. Jossey-Bass? 1997.
  3. Moffic HS. To knock or not to knock at Kaiser Permanente in California. Psychiatric Times. August 16, 2022.