In their excellent article about bariatric surgery, Stephen J. Dubner and Steven D. Levitt (Freakonomics, Nov. 18) mention that the procedure ”often produces complications – physiological ones, to be sure, but also perhaps psychological ones.” As a psychiatrist, I have no doubt that a morbidly obese patient without other medical cause for obesity (i.e., thyroid disease) already has a severe psychiatric problem. Without treating the compulsion that underlies such behavior, it is no wonder that patients who have surgery but no psychiatric treatment may develop ”new” psychiatric symptoms, like gambling, compulsive shopping and alcoholism.
In a way, there is a simple economics to it. The patient who undergoes surgery, perhaps even covered by insurance, does not pay the psychological price that would be required to come to understand why he thwarts himself so. And so the psychological problem, having not received its due sum, returns in a new form.
Amanda Itzkoff, M.D.
Department of Psychiatry
Mount Sinai Hospital