Psychodynamic Therapy vs. Cognitive Behavioral Therapy vs. Psychiatric Medication

Today was probably my most exciting day since I have been at VIMHANS. There are two key things that happened. First, I found myself in the middle of a battle. By saying a battle, I not only mean it metaphorically but literally. At VIMHANS, there are all kinds of psychologists that use all kinds of different treatments. They are mostly divided into using Cognitive Behavioral Therapy and Psychodynamic Therapy. And then there are the psychiatrists who mostly simply prescribe medication and sometimes refer patients for therapy when needed (but most of the time they don't). As I mentioned before, the group who I am doing my internship with is from a psychodynamically based school. This is the only school in India that has this focus. Every Wednesday, Thursday and Friday, there are case presentations on particular patients. One person presents and the rest discusses the patient's treatment, symptoms and further approach afterwards. Today's presentation was on a patient who suffers from insomnia. After the presentation, one of the interns asked the question how we could look at this patient from a more psychodynamic point of view. And the battle started.

A psychodynamic perspective is not accepted by a lot of people at VIMHANS as it turns out. In general, it is a much smaller portion of clinicians who apply this approach but it should still be respected as an option. And when the interns didn't see that respect, they started defending their school and what they are taught. In particular, there was this one Senior Psychiatrist who was strongly opposed a psychodynamic perspective. She literally said that such an approach is "crab." And that schools in India are going down if they are teaching such things. They should revise their syllabus and truly think about what they are teaching their students. Because teaching them a psycho-dynamic approach is harming them. Other comments that were made were that "psychoanalysis is dead" or that "just because a patient as a child was not hugged by his mother has caused insomnia cannot be used as a valid explanation." Another psychiatrist said, "we in fact only need physicians and nothing else. If we would be far enough with our research and found what medication helps what patients exactly, then we would not need therapy at all."

After those comments were made the whole entire room was on fire. It seemed as if everybody was fighting with everybody. It was amazing to watch and to listen. And it was so interesting to see in what conflict people are with each other even though they are supposed to work together. I was very surprised about the comments and about the way people spoke to each other.     

Another experience that I had today and want to share briefly, I made at day care. Today, everything seemed crazy, a lot of people didn't know what they are doing and too many things came up at the same time. There was a young man who came in as a new patient and nobody had time to sit down with his father and him. This is why they send me and another girl to interview the father and do some tests with the young man. I picked to do the baseline assessment with the patient and the other intern agreed to interview the father.

I was not ready for this at all and I think I totally screwed up. Very every much so. I felt horrible for the young man. He was diagnosed with schizophrenia and was on a lot of medication. He was totally withdrawn and it made it very difficult to talk to him. But I also wasn't sure if he understood everything. Even though his father said he speaks English well and is totally comfortable speaking English, I kind of had the feeling that if I would have spoken Hindi, I could have reached him better. In particular when I asked him about school and about his home, there were things that I didn't really understand or had no sensitivity to because I simply wasn't aware of Indian culture. For example, when I was asking him about his daily routine such as what he did yesterday, what he learned in school or what he ate, I had no idea what he would answer so I couldn't give him examples to try to give him suggestions about what I wanted to hear from him. In general, I really don't think I did a very good job and I felt horrible afterwards.