When a woman is pregnant she goes to see an obstetrician. If someone has a heart problem, he goes to see a cardiologist. When someone suffers from depression or anxiety, they are often unsure of where to turn for help. And if they see a psychiatrist, they are sometimes not even sure about what type of doctor they are seeing. After 25 years of practice, I continue to be struck by how many otherwise knowledgeable and well educated people do not know the difference between a psychiatrist and a psychologist.
Psychiatry is a medical specialty, just like obstetrics or cardiology. It is also one of the most rapidly advancing medical specialties. Its scientific foundation is neuroscience, which is growing at a more rapid pace than any other branch of science. Psychiatrists are more closely akin to neurologists than psychologists. After all, both specialties are regulated by the same American Board of Psychiatry and Neurology. Yet the general public and even other medical specialists still tend to envision psychiatrists as sitting behind a couch scribbling Freudian jargon, while interpreting their patients’ dreams.
So before venturing further into any discussion about The Mindful Brain, I would like to share some of my thoughts about what psychiatry is and what a psychiatrist does.
- A psychiatrist is a fully trained medical doctor (MD). The process of becoming a psychiatrist involves the standard four years of medical school followed by a year long hospital internship, rotating through all of the major medical specialties, including intensive care medicine and surgery. This is followed by three or more years of additional specialized training.
- Psychiatry focuses on brain disorders that affect behavior, thought, mood, and cognition. These can be either primary disorders themselves or the result of general medical conditions or substance use.
- Psychiatric disorders are the result of complex interactions of genes and the environment. Some psychiatric disorders begin to develop during fetal life, while others appear much later, even in advanced old age.
- Psychiatric disorders are very common, affecting anywhere from 25% to 50% of the general population in various studies. They can range from very mild to extremely severe and disabling.
- The complete assessment of psychiatric disorders almost always requires information provided by someone who knows the patient well.
- As a fully trained physician, a psychiatrist can integrate biological, psychological, and social factors in order to render an accurate diagnosis, and administer pharmacologic/physical treatments as well as psychotherapeutic treatments to repair both the brain and the mind.
- As with all medical disciplines, the best outcome in psychiatry is full remission and recovery. The worst outcomes are death from suicide, homicide, self-neglect, coexisting medical illness, or rarely, from treatment itself.
- Social and occupational disability can occur with some psychiatric disorders but most are not disabling and with proper treatment, most patients can lead full, productive, and happy lives.
- Psychiatric diagnoses have far more reliability than ever before, especially as the underlying brain pathophysiology of specific psychiatric disorders becomes better understood.
- Severe psychiatric disorders can sometimes impair the insight of the person who has the illness, which can interfere with treatment.
- Many current medication treatments came about because of accidental discoveries but groundbreaking advances in genetics and neuroscience are leading to breakthroughs that are reshaping the treatment of psychiatric disorders.
- Drug treatments and neurostimulation are regulated by the FDA and are approved for specific uses based on large, placebo-controlled trials but the various forms of psychotherapy and other “alternative” treatments are not, some of which have little, if any, proven value.
- The medical model is as appropriate for the treatment of psychiatric disorders as it is for the treatment of cancer or heart disease. However, social stigma, political influences and the preponderance of non-physicians in the mental health care system (psychologists, social workers, pastoral counselors, etc.) have shifted psychiatric treatment towards a predominantly social model.
- These allied health care professionals are usually highly trained and quite competent with their own unique skills and expertise. They share the same goal, which is to help the patient make a full recovery and enjoy their full, human potential. Unfortunately, in some cases the lack of any medical evaluation can result in wrong diagnosis and incorrect treatment or even lack of treatment.
- Medical doctors are certainly not perfect either and sometimes fail to correctly diagnose or properly treat a patient. Criticism of individual physicians may be entirely justified in some circumstances. For example, some obstetricians may indeed perform more caesarian sections than are necessary and some cardiologists may perform more cardiac catheterizations than are necessary. And it is certainly true that the health care delivery system in this country is in need of improvement in a number of respects. But rarely does one hear wholesale criticism of a specific medical specialty. Psychiatry however, has more detractors and self-appointed critics than any other medical specialty, which is the product of a malignant mix of ignorance and self-interest, especially by cults, such as Scientology, which offer their own unscientific “solutions” to mental illness, usually at a substantial price.
- The future of psychiatry is bright because it is intimately linked to neuroscience discoveries, which will ultimately delineate specific brain pathways underlying psychiatric illness and treatment.
- But even within the specialty of psychiatry itself there are differences of opinion and differences in clinical practice. For most of the 20th century, American psychiatry was heavily influenced by the psychoanalytic ideas of Sigmund Freud and his followers. While many of these ideas can still provide useful insights into human nature, our growing understanding of the basic brain problems responsible for most psychiatric symptoms will vastly change the practice of clinical psychiatry.
I have chosen to devote my efforts to one of the most important and exciting developments in modern psychiatry--transcranial magnetic stimulation (TMS). My next post will provide an introduction to TMS.
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