The psychiatric mystique

For many people unfamiliar with the experience, the thought of seeing a psychiatrist seems a very mysterious business – akin to visiting a fortune teller or psychic.

Many people seem to have little idea of what a psychiatrist actually does, what training is involved and what might be uncovered during a session. As a result, most visit a psychiatrist with a certain degree of trepidation.

Unfortunately, Hollywood characterizations don’t help much. Most often, these movie portrayals are unrealistic and not very flattering of the profession.

I’d like to help dispel some of the mystery.

Psychiatrists are medical specialists just like cardiologists, surgeons, obstetricians, dermatologists or others. This means the educational training usually involves an undergraduate university degree of three or four years, a medical degree of three or four years, an internship of one or two years, a residency of an additional four to six years and sometimes a postgraduate degree like a PhD for a further three to five years.

In psychiatry, the special interest and training is in mental illness, which can include everything from attention deficit disorder to schizophrenia. Some specialize in one illness or group of illnesses like depression and other mood disorders while others specialize in certain age groups such as children or the elderly.

Psychiatry and psychology are also often confused. Although there is a big overlap between the two disciplines, the essential difference is that psychiatrists are medically trained while psychologists are not.

Many people have the mistaken idea that psychiatrists are only interested in prescribing medication and are not interested in psychotherapy. This is not true.

Psychiatrists are unique in the ability to prescribe medication for mental illness, but are also trained in various types of psychotherapy and are still interested in other aspects of a patient’s life and problems. In most cases, education and therapy are necessary in addition to medication.

A lot has changed in the field since the days of Freud - and we shouldn’t expect psychiatry to look the same as it did a century or more ago. Today we are very fortunate to have a variety of effective, evidence-based treatments both pharmaceutical and not.

Confusion also arises because patients sometimes have unrealistic expectations about what therapy involves and how much time it takes. This confusion is fostered by media portrayals and fringe therapists with little training who may offer strange therapies based on little evidence and flimsy theories.

If a psychiatrist doesn’t offer a particular therapy it often isn’t due to unwillingness or inability to conduct that treatment, but is because of a belief the therapy isn’t necessary in the specific situation.

Generally a psychiatrist will tailor treatment to meet the specific needs of the individual based on the presenting problems and what the patient wants. We are not usually trying to address every problem a person has and we don’t try to completely re-shape a personality.

Unfortunately, there are still many problems for which we don’t have very good solutions and many others that do not require psychotherapy. Sometimes people in the depths of depression become troubled about things from their past that do not normally concern them. In many cases, treatment of the depression is the first step rather than focusing on the particulars of a temporary preoccupation.

If you are seeing a psychiatrist and are uncertain of an approach or treatment focus, the best thing to do is ask about it. Your psychiatrist may explain his or her reasons or take your lead and pursue another avenue with you.

Remember, the average psychiatrist will have seen your problem hundreds if not thousands of times.

Something that seems strange, inexplicable and frightening to you may be very familiar to your doctor and it is likely the psychiatrist has a well practiced approach to the problem. This is one reason why simply talking with a psychiatrist for the first time is often very comforting and leads to substantial improvement even before any specific treatment is prescribed.

Your psychiatrist is not interested in judging you and will not think less of you because of the problems you bring. We deal with difficult situations all the time and are here for one reason – to hear your problem and work with you to find a solution.

When you are motivated, your psychiatrist will usually be quite interested in working with you and will not usually give up unless you do. However, if you give up, stop taking your medication or attending appointments, the psychiatrist will not be able to help you.

If you want to see a psychiatrist, speak with your family doctor and ask for a referral. 

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.