Psychotherapy vs. pharmacotherapy: are psychiatrists polarized?--A survey of academic and clinical faculty.

Recent debate about the Osheroff vs. Chestnut Lodge case has highlighted the potential for polarization in psychiatric treatment. The degree to which community clinical psychiatric practice is polarized between psychological and biological treatments is not known. There are limitations in the combined treatment studies performed to date that influence their applicability to treatment planning in the community setting. A nearly exclusive focus on mood disorders and a neglect of the role of concurrent personality disorders and treatment interactions are among these. The data base available to guide a truly integrated practice of differential therapeutics is therefore quite limited. Against this background, we surveyed academic and clinical psychiatric faculty to determine treatment practices and rationales in three case with both Axis I and Axis II diagnoses. In each case, greater than 75% would utilize psychotherapy and consider its omission inappropriate. Medication use varied significantly from case to case. Our findings suggest that practicing psychiatrists combine psychotherapy and pharmacotherapy and that the perceived polarization between "biological" and "psychosocial" psychiatry may be more a matter of "philosophy" than practice.