Does It Bother You?

[Psyzlm]

I've wanted to become a psychiatrist for many years now. I even wanted to be one regardless of it being a stigmatized profession due to its clearly apparent pseudo-scientific nature, but now it's starting to bother me. I often ask myself: What is the point in being a doctor if you have no hope in curing someone, or at least guaranteed to help someone? After all, if there is no science involved when it comes to distinguishing mental health illnesses, there can never really be any cures. Don't you think it's disturbing how psychiatric "Doctors" can have the power to section people based on their opinion that they have a mental illness with no scientific evidence supporting there claim whatsoever? What about the people who say they're not ill and have been misdiagnosed? Would it be appropriate for a profession that cannot rely on a scientific platform simply because of lack thereof, to believe in the concept that "Crazy people don't know they're crazy"?

I've always believed that in medicine every claim should be back up with a fact, or at least a claim so truthful it can be considered factual. The diagnoses made can be subjective from one psychiatrist to the next. Lets use the example of ADHD, now whether this is a disorder on its own merit is debateable. I personally don't buy it, and that said, my opinion is just as valid as a doctor who claims it exists because they have no evidence for it either. How can you distinguish between someone who generally misbehaves constantly, destructive in both the home and school environment, to someone who cannot help it? It is very possible that ADHD is just another spin off of autism in my opinion, like AS. I think it's disgraceful seeing some children given the easy ride by masquerading problems they themselves can control under some mental disorder, and being fed potentially toxic drugs based on no evidence whatsoever, but subjective opinions, simply because the parents demanded any excuse for their child's behaviour for their kid's sake and / or perhaps even an excuse for their bad parenting.

Does any of this bother any of you? I really want to work in mental health, and it seems unfortunate that the only real two professions are psychology and psychiatry. If no one can give me a reasonable explanation into why psychiatry would be suitable and beneficial to patients, and have values that cannot be obtained by a competent psychologist (The title of doctor aside), then maybe I should look into neurology, which isn't what I really want to do because I want to be with the patients throughout their treatment and form a relationship with them, but it seems it is an appropriate assumption to say that if there were to be any cure for the REAL mental illnesses out there (Which are only a handful) it's going to be down to neuroscience.

I feel weird in spring, apparently that's a disorder. Give me some pills?
I'm addicted to coffee, do you think you can medicate me with that also? I'm sorry, but it's horrible to have a strong dream of mine pretty much destroyed. There's still a chance I might pursue this career but to be honest, is there really any hope in psychiatry? I want to also understand how you guys would understand and deal with these claims, because it just seems to me that any M.D is just trying to make a good job out of a bad profession.

Thank you.

[craigos25]

I am currently working as a RMN or RNMH (Psychiatric Nurse) in the field of Child Psychiatry and after reading your post i feel you have raised some interesting points! Psychiatry is a strange field to work in....as a nurse working with drs i have seen different approaches used. Some Drs will not deliver any therapies (such as CBT) as they argue that is the role of the Psychologist. Some Drs 'only deal with the assessment of mental state and medication element' of care. Whereas some Drs will deliver all interventions. Questionably though, what scientific evidence can be seen to suggest a patient has a mental illness? Psychiatry in my opinion is about assessment, unerstanding overtime how a patient presents. Although i am not a Dr (yet), i do consider that there is 'some' science involved within Psychiatry. In response to your post however, Doctors section people on the basis that they COULD be suffering from a mental illness and need assessing (Section 2 of The Mental Health Act). A patient cannot be treat for a mental illness until it has been firmly established that he / she is suffering from one!!

I personally think that you need to spend some time in the field of Psychiatry (if you have not!). It is a very rewading profession. I wont however specialise in this field when (and if) i qualify as a Dr.

Good luck with whatever you decide to do. I dont mind if you want to ask any questions!

Craig x

[Psyzlm]

I am currently working as a RMN or RNMH (Psychiatric Nurse) in the field of Child Psychiatry and after reading your post i feel you have raised some interesting points! Psychiatry is a strange field to work in....as a nurse working with drs i have seen different approaches used. Some Drs will not deliver any therapies (such as CBT) as they argue that is the role of the Psychologist. Some Drs 'only deal with the assessment of mental state and medication element' of care. Whereas some Drs will deliver all interventions. Questionably though, what scientific evidence can be seen to suggest a patient has a mental illness? Psychiatry in my opinion is about assessment, unerstanding overtime how a patient presents. Although i am not a Dr (yet), i do consider that there is 'some' science involved within Psychiatry. In response to your post however, Doctors section people on the basis that they COULD be suffering from a mental illness and need assessing (Section 2 of The Mental Health Act). A patient cannot be treat for a mental illness until it has been firmly established that he / she is suffering from one!!

I personally think that you need to spend some time in the field of Psychiatry (if you have not!). It is a very rewading profession. I wont however specialise in this field when (and if) i qualify as a Dr.

Good luck with whatever you decide to do. I dont mind if you want to ask any questions!

Craig x

Cheers for the reply. I'm sure it's a very interesting field. I enjoy simply reading books on it! I'm just having doubts that it's something that I should do for a living. I've even been considering neurosurgery recently! The problem is I really want to work with mental health, but I want to have the responsibilities a doctor has in that field, and have the platform of medical science behind me. It's going to be a hard choice. For now I'll stop worrying and wait until med school (If I get in ) and make my choice then. If I have questions I'll contact you, I'm sure I do but I can't think of any now...

By the way, if you don't mind me asking, what are you planning to specialise in?

[craigos25]

Im un-decided! Maybe emergency medicine, obs & gynae or paeds! Certainly not psychiatry!!!

[belis]

Im un-decided! Maybe emergency medicine, obs & gynae or paeds! Certainly not psychiatry!!!

You will change your mind many many times. There are some specialities out there that you have not even heard about let alone considered at this stage. Who knows, you may even give psychiatry a second thought after doing a plecment in that area.

[andy2]

If I may say so I think you have a some rather funny ideas about psychiatry - although to be fair they are commonly expressed funny ideas.

To examine your points in turn
1) Psychiatry is not based on science - this is nonsense. There is an established and growing body of evidence of the biological basis and effects of psychiatric illnesses. From the genetic studys into conditions such as bi-polar and schizophrenia to anatomical, neurotrophic and neurotransmitter basis of diseases such as Obesssive Compulsive Disorder and Depression these are undeniably scientifically quantifiable,describable and investigatable diseases.
I have little doubt that future scientific discoverys will further improve the understanding and treatment of psychiatric disorders, and may show that present classification systems are incorrect (e.g. is Schizophrenia really one disease?), but the same could be said for many branches of medicine.
The recent developments in psychopharmacology (Selective Serotonin Reuptake Inhibitors, atypical anti-psychotics etc...) have been developed using further insights into the biology of psychiatric diseases.
2) Patients don't get better - try working in Intensive Care or Oncology! The majority of patients with psychiatric conditions do get better - very few are truly 'treatment resistant'. Certainly many diseases run a chronic or relapsing and remitting course - but then no one is put off endocrinology because diabetes can only be managed and not cured (experimental stem cell therapy aside).
3) ADHD is not a real disease - well its a frequently proferred opinion, usually by people who are opposed to the idea of medication. However there are undeniably a group of children (and infact adults) who display a collection of symptoms including restlessness, poor concentration and hyperactivity - symptoms which receed if treated, and which if left untreated lead to a higher risk of poor school attainment, substance misuse and social dysfunction. In addition many patients with ADHD also have co-existent neurolingusitic and cognitive problems, or other psychiatric conditions (Autism and Tic disorder are pretty common).
4) Social control by detaining people under the mental health act on a whim - again simply not true. Although there may not be a simple blood test for, say, severe depression leading to risk to life or uncontrolled schizophrenia these can be diagnosed in a systematic and reproducible way. If you ever meet someone with a severe mental disorder you'll recognise them as genuinely ill - people are not 'locked up' simply because they are ecentric or socially inconvient.

It is true that not all psychiatrists agree on the treatments - some are more in favour of psychological therapies others lean more towards pharmacology, although as is often the case most use a mixture of therapies as seems appropriate.

There is a huge suspicion of psychiatry, and psychiatric disorders - and for some reason people seem to be far more happy questioning the existence of psychiatric disorder than physical ones. There is also a major anti-psychiatry lobby, which is often backed by a rather shadowy cult who frequently distribute apparently reputable materials without being clear where they come from.

An inquiring, sceptical mind is to be encouraged - but seriously don't believe all the BS which is written about psychiatry.

[thepriceofreality]

my 2 cents... basically what "andy2" said.

Also, you guys shouldn't worry about what you want to specialise in..... it's way way way to early too think about that. If I were you, I'd keep an open mind about every specialty.... after all you only really need to think about career paths after your foundation years!

good luck with your applications

[Luci]

also what andy2 said.
Plus, my dad's a psychiatrist (for the elderly) and he loves his job, sometimes he goes on and on (sigh..) on how it's so rewarding and satisfying to make people happier or better in a way.
As a psychiatrist you really do help people and they'll usually be very grateful (of course, there are exceptions...).
Plus, like you mentioned, there is a lot more patient contact.

craig mentioned doing some more shadowing, do so!
Experience again why you want to become a psychiatrist.

And does it really bother you that some people seem to think there is no science behind psychiatry? As long as you know that there is and as long as you help your patients (and actually enjoy what you do); that should (in my opinion!) be more important than anything else.

Good luck getting your dream back, I hope you succeed

[Eponine_hugo]

I've been doing a psych placement recently and was shocked to discover ECT is still used!!! To me that seems barbaric, what do you guys think of this?

[Luci]

Actually it's not barbaric at all!
It used to be of course..
Now, you get a short anaesthetic so you're sleeping and you get an IV though which they inject a muscle relaxant to make sure you won't make all those weird movements. They measure your blood pressure constantly and on top of that they place some kind of band over the other arm that basically stops the muscle relaxant to reach one hand; this is for visual control so that they can see when you have seizures.
People don't experience any pain at all.
This can be done unilateral and bilateral (so impulses on one side of the head, or on both) unilateral ECT's have no negative side effect. With the bilateral people could suffer from short term memory loss, which lasts at most 3 weeks. Those are usually things like people forgetting how to use a remote control...

ECT's can be extremely benificial to people! It's usually about 6 times and between each ECT they measure e.g. your depression and if you get below a certain point twice, they stop the procedure. But it has been proven that people who suffer from extreme depression really benefit from ECT's.

so barbaric, hardly but I get where you're coming from!

edit: I'd like to add that people do consent (of course)! and personally it reminds me of getting a cardioversion, some people who have arythmia come to the hospital to get a shock to their heart (exactly as what you see in the movies when people die and they "charge the pedals". It's a weird thing to see at first!
That doesn't hurt people either, it's beneficial