Ann Arbor on the Couch

continued

because her sexy ad-executive husband, Don, is cheating on her.

Betty and Don Draper live inside the television world of Mad Men. The show is set in the early 1960s, when the standard treatment for mental illness was the "talking cure" promoted by Sigmund Freud at the start of the twentieth century. For many patients, that meant psychoanalysis--daily sessions on the couch that might stretch on for years.

Since then, anti-depressants and other drugs have revolutionized psychiatry. "If you looked at the major departments of psychiatry in the 1960s, in the major medical schools, all of the chairs were psychoanalysts," says U-M psychiatry professor Ken Silk. Yet by the mid-1980s, "there were very, very few psychoanalysts that were department chairs." Silk says he can think of only a couple who survived "the shift that occurred in academic medicine, away from psychoanalysis, toward psychobiology."

Today, Betty Draper's doctor would be far more likely to prescribe medication or, at most, short-term psychotherapy. Compared to psychoanalysis, psychotherapy "has more modest aims and goals," explains Ron Benson, senior training analyst with the Michigan Psychoanalytic Institute (MPI). Whereas psychotherapy is often used to help people cope with their current problems, Benson says "psychoanalysis's goal is restructuring the patient's mental functioning"--a process that can take 1,000 or more sessions on the couch.