You Mean You Want to Talk? A Patient’s Perspective on Speed Psychiatry


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By Amy M. Collins, associate editor

A recent post on our blog describing how many psychiatrists have abandoned psychotherapy in favor of short consultations and pharmacotherapy struck a chord with me.

Eleven years ago I moved abroad to live and work in a new country. I looked forward to great adventures, but I didn’t expect the sudden, crippling anxiety that spiraled into daily panic attacks lasting for hours. After several months I flew home to seek treatment.

I spent over half an hour in the waiting room wanting to crawl out of my too-tight skin. When he finally called me into his office, the psychiatrist smelled strongly of lunch and was still cramming a sandwich into his mouth—thus, I supposed, the long wait. I was still describing my symptoms when he shoved a checklist into my hands. I skimmed the symptoms—palpitations, trouble breathing, chest tightness, a need to escape—and realized I had them all. Bingo! His five-minute diagnosis: panic disorder.

I was overwhelmed with emotions: a mixture of relief to learn there was a reason for the mayhem, and something like a feeling of failure. When I started to explain the possible culprits (the move, the new language, the new culture), the doctor cut me off and handed me a prescription for Zoloft, explaining that antidepressants were also being used to treat anxiety, and that I’d probably feel worse before feeling better.

“I’m not sure I want to take medication. Can’t I just explain why I think this might be happening?” I asked.

The doctor wrinkled his brow. “You mean you want to talk?” he scoffed. “You won’t get better by talking. You need to be medicated.” When I started to cry, his look softened. “Listen, take these pills for a month and when you come back we can talk a little more.”

He stood up to let me out. I’d been in his office for less than 10 minutes.

But there’s one thing I can thank him for. He unintentionally laid a challenge at my feet when he told me I’d only get better with drug therapy. I wasn’t antimedication, but I was against using it as a first resort. For me, it felt wrong. As I looked at the prescription he’d written (Zoloft plus long-acting Xanax plus rescue Valium), I thought to myself, “Sure, I won’t have panic with these meds. Or a pulse!”

Instead, I sought treatment from a therapist who wasn’t opposed to talking, learned coping mechanisms, employed relaxation techniques, cut out caffeine, and read everything I could on panic to understand the mechanisms behind the disorder. It was a long hard fight, but 11 years later I see the attacks for what they are: a textbook pattern that culminates in an attack only when fear is present. Instead of stopping everything I’m doing at the onset of an attack, I tell myself I’m not scared, that I’ve handled hundreds and this one will be no different. Using this approach, nowadays panic fizzles out like a wet firecracker, never really taking off or exploding.

With over 2 million U.S. adults living with panic disorder, and twice as many women as men suffering from it, health care providers should ensure they give patients all available options for treatment. Medication may work for some, but there are alternatives. I know because, despite what my psychiatrist said, I did get better.

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Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. CLabrey, online lpn March 28, 2011 at 4:15 am

    I saw a psychologist a few years ago, and we had a long chat, lasted for about an hour, and as I was about to leave, she asked me, “Do you feel that you need any medication to help you? I don’t prescribe but I can refer you to a psychiatrist.” I was quite shocked. I didn’t want meds, would have gone straight to the psychiatrist if I had wanted them, and here she was offering them to me! I saw her twice more and then stopped – but at least she didn’t offer meds again. I thought, at the time, that it was a bit of a cop out, but maybe she thought I didn’t know the difference between a psychologist and psychiatrist and had been expecting a prescription …

  2. […] has a post about using non drug therapy for panic attacks.  I agree, that is the place to start the […]

  3. Are You a Well Being? « Off the Charts March 23, 2011 at 11:20 am

    […] even in psychiatry, which has morphed into a “get-em-in, get-em-out” assembly line. (See this recent post re. the demise of talk therapy.)  I hear from nurses who say that we’ve cut costs as much as we […]

  4. Dr Dean March 20, 2011 at 1:03 pm

    I agree strongly choices should be given regarding treatment options. I also think many can control this problem with effort.

    I run into the opposite problem though usually. Most patients stop me when I start giving them options.
    “Can’t you just give me a pill?”

  5. Shawn Kennedy March 18, 2011 at 1:52 pm

    Excellent points. Unfortunately, in this day of same-day surgeries and drive-through deliveries, health care providers are too often showing that time is money and too precious to spend with patients. How did we let this happent?

  6. strugglingwithbipolar March 18, 2011 at 1:26 pm

    This is a great post. My therapists believe in exposure therapy for treatment of anxiety including panic disorder. I can see medication to supplement the issues, but not necessarily as a primary for of treatment. Then again, I’m the patient not the treater.

  7. Peggy March 18, 2011 at 12:14 pm

    Bravo! Thanks for writing this. I have been so discouraged with the eager prescribing seen for such problems. Our country is overmedicated, even our children. I know that sometimes a drug may be needed, but it shouldn’t be the first line of defense, as you stated. Please continue to speak out and share your story.

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