Tell the truth

January 26, 1994|By Art Buchwald

ONE of the big changes we'll see in 1994 is the way in which people with psychiatric problems are treated. All the health plans have traditionally been reluctant to pay for mental illness and have now imposed a time limit on how long a patient is allowed to feel really lousy.

While pills are playing their role in helping patients, the one-on-one 50-minute therapy session is rapidly sinking in the west.

As my insurance adjuster complained to me, "Psychiatrists take too long to find out why a person is afraid of heights."

"They are sluggish," I admitted, "but psychiatry is one of the few medical art forms where you let the patient set his own pace."

"Exactly," he said, "and insurance companies don't like it one bit. If the doctor can't find out what's bugging his patient in a couple of office visits, then we say the doctor should turn in his couch."

"What would replace it?"

"As of now a psychiatrist cannot rush his patient's story. The person seeking help is the one who has to discover what is wrong with himself. This could take -- and has taken -- 10 years. Neither the doctor nor the person he is caring for is in a hurry, particularly if someone else is paying the bill.

"Let's say that a man hated his mother because she never packed him a decent school lunch and he became anorexic because she forbade him to eat airline food. The psychiatrist spots this in the first week, but he can't tell his patient what's bugging him until the patient gains the knowledge himself through a revealing dream, preferably in the second or third year.

"Now suppose the same patient goes into a group therapy session with other disoriented people.

"The patient says, 'I am anorexic because I have no appetite for airline food, and I think I hate a member of my family, although I can't yet identify which one it is.'

"Now the guy sitting next to him says, 'You're full of it, and you're a crybaby besides. No one likes airline food, and you'd be crazy if you ate those meals -- so get off it because most of us have to catch the last bus home.'

"Can you see the difference between this therapy and the one with only the doctor? The patient responds, 'I know it's more than that. If I could only plumb my subconscious to discover which person made me hate airline food, I would be cured.'

"The woman next to him says, 'Does her name start with an M?'

" 'It could,' the patient says, fidgeting in his chair.

" 'How about an O after the M?'

" 'Please don't spell it out,' the patient implores.

"Someone else yells, 'T, then H, and E.'

"And when the last person adds R, the patient crumbles to the floor in a fetal position and cries, 'Mother.' With one group session, our insurance company can save $10,000."

"So that's where psychiatry is going," I said.

"What choice do we have? The patient either tells his story to a doctor who just nods his head while the patient snows him, or he tries it out on a group of people who are on to him before he takes his overcoat off."

"That isn't what Freud had in mind," I told him.

"That's because Freud never charged our insurance company $150 for a 50-minute session."

Art Buchwald is a syndicated columnist.

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