Less-Traveled Pathways Can Lead to Desired Outcomes, Too

I am always happy to see behavioral healthcare professionals get some time and attention on the stage of national media outlets. For example, the New York Times has been publishing opinion pieces by Richard A. Friedman, MD, for several years now, and I always enjoy reading what he has to say. He is a psychiatrist who tends to focus on the biology and neurology of behavioral health conditions, as well as the solutions that emanate from this focus. He is very knowledgeable, honest and compelling.

However, I am troubled by the fact that major news organizations rarely focus their lens into other sources or solutions for behavioral health conditions. This is troubling since we have a wide range of clinicians and researchers providing valuable clinical models, treatment protocols, and research evidence outside a narrow biological focus. In fact, we have better evidence-based treatments for some disorders today other than medications – you should do the literature review on this if you are depressed or can’t sleep.

I think there are three reasons for this broad public media distortion today. First, people want easier solutions, and it is easier to take a pill than commit to a course of psychological treatment. Second, people have been led to believe that the science behind medications is better than that behind psychotherapy, in part because the FDA must approve medications and psychotherapy is not regulated. Third, the pharmaceutical industry has a never-ending stream of commercials on television and the internet, and I don’t think I have ever seen a commercial for psychotherapy.

Positive promotion is not the only issue. What about the negative aspects of your prescribed product, like the possibility that you may be harmed by medications? Exhibit A today would be chronic pain patients who have relied on opiates. Most of them never knew there was an alternative with cognitive behavioral therapy tools that are both safe and effective. We have witnessed numerous mind-numbing commercials warning us of side effects from various medications, and yet pain patients were led down the path to addiction with few warnings.

I am as interested in effective medications as anyone else, but we all need to be wary that we could be signing onto unknown long-term consequences with medications. My emphasis here is on marketing more than science. We have a significant imbalance in the marketing forces between biological and other solutions. It may be better for some conditions to learn meditation than to take a pill, but meditation will never have the resources to win a media campaign in opposition to medication.

The debate that I encourage is not simply focused on biological and psychological sources of improvement for people in distress. I am in support of all sources of improvement. I am concerned about how people lack awareness or understanding of existing solutions today, and more importantly, how this misunderstanding is a well-funded and well-executed enterprise. Many successful corporations have a vested interest in suppressing that fact that powerful non-clinical solutions exist.

Less expensive alternative solutions

We possess a wide range of healthcare solutions today. A closer look at large pharmaceutical companies highlights this point. Last year, GlaxoSmithKline and Pfizer combined to form a new consumer products entity with combined sales of nearly $13 billion because they know that many people can be helped enormously with over-the-counter solutions. Their message is to treat a mild condition today so that you don’t need an inpatient admission or an emergency room visit tomorrow. Inexpensive solutions can have an enormous impact on health status and healthcare costs.

Shifting to the world of serious mental illness, we can see another example of practical and low-cost solutions with significant results. Many people with illnesses such as schizophrenia or bipolar disorder are thankful for the medications which have stabilized their lives, but many are also deeply grateful for how their functioning in daily life has been enhanced due to the support of a peer support counselor. They want to achieve recovery and resiliency, not just symptom improvement, and they know that this cannot be found in a medicine container.

We live in an age of exciting technological innovation, from medical interventions to digital solutions to large data and artificial intelligence products, and so it is not surprising that our emphasis is on the next great innovation. This does a disservice to many people who could benefit today from existing solutions that don’t require technology or innovation. For example, psychotherapy is remarkably effective (the average effect size is 0.8, which is large) and many people with serious mental illnesses are high functioning today because they had a peer to coach them.

I am arguing in many ways for public health solutions rather than just medical ones. The Bill and Melinda Gates Foundation is investing in the availability of toilets worldwide, rather than just medicines. They invest in many solutions, but they understand the profound impact of practical, relatively low-cost solutions which prevent diseases. Then there are the “social determinants of health” which former treasury secretary Robert Rubin promotes in a 2019 editorial: “effective social programs provide access to good nutrition, clean and safe shelter and a subsistence income, which are critical to avoiding disease.”

We must believe in all of it: scientific innovation, the power of people helping and healing others, and simple positive changes to life’s everyday activities. All of them can have a powerful impact and they all must be valued. Our vision and values are as important as our latest discovery. We are all accountable for endorsing the vision and values that we move forward with in society. Let’s not fall victim to thinking that the latest developments always replace or outdo the older, enduring solutions.

Let’s finish on what may, one day, be personal. If you get sick, you will want the most effective medication, procedure, or device available from the highly profitable medical industry. You will also want to have access to psychological treatments like cognitive behavioral therapy or mindfulness if they have been proven effective for your condition. You would also like the simple, practical solutions that might improve your life, like a course in sleep hygiene. As the song says, whatever gets you through the night is all right.