From Jesse Dubrinski

I found Horwitz’s description of changing reimbursement schemes for psychiatrists as described from page 74 to be most interesting. Here Horowitz describes an important component to Psychiatry developing a more scientific face. It is interesting because as Horowitz shows dynamic psychiatry does not lend itself well to pay schemes used by insurance companies. Dynamic psychiatry seems to represent a personal journey between patient and psychiatrist, whereby the two parties work at deep-seated mental trauma, which may lead to revelations about a person’s mental state. Due to the way dynamic psychiatry works it appears that the healing journey was completely up to the progress of the individual and could be an indefinite and costly process. It is no wonder then why cost conscious insurance companies would back diagnostic psychiatry that attempted to put a specific label on peoples mental suffering and provide specific treatment plans for specific ailments. The changes backed by insurance companies seem to push towards a more concise doctor/ patient relationship, which would presumably cut costs as well.

I also wanted to mention that I found the dimensions of psychiatry and psychology to be a bit blurred in this book. Based on our in class description last week of the differences between psychology and psychiatry, it seemed like early psychiatry in particular may have looked a lot like psychology. Horowitz seems to do little to address the difference, and offers little explanation of drug-based solutions particularly in psychiatry’s earliest phases. Whether or not the two professions were once co-joined and have split or not, is not made clear, however I think even a brief discussion on the topic would be helpful.