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Psychiatrists January 27, 2010

Posted by Crazy Mermaid in mental illness, Psychiatrists, Recovery.
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There’s nothing more important to a person with a mental illness than their relationship with their psychiatrist.

Some people, not realizing the critical difference between a psychiatrist and other medical disciplines, make the mistake of substituting their General Practictioner (GP) or other “mainstream” doctor or nurse for the services of a psychiatrist. That’s like going to a podiatrist (foot doctor) to get a mammogram (breast exam).

The primary difference between a psychiatrist and another type of doctor is that the psychiatrist has been trained in diagnostic evaluation of mental disorders. This is an under-appreciated fact in the medical community as well as in the general public.

For example, if a patient comes into a GP’s office and announces that he has a broken ankle, the GP won’t begin treating the broken ankle without taking xrays and verifying the patient’s self-diagnosis. Generally, the GP will have the skills necessary to perform those tasks.

But that same GP won’t hesitate to begin treating a patient coming into his office complaining of depression. Without verifying that the patient has depression rather than bipolar disorder or a number of other psychiatric disorders, the GP begins treatment of the patient. He has neither the knowledge nor the skill necessary to do the diagnosis, and yet he has no qualms about treatment. This type of thing happens more frequently than not.

The right psychiatrist assesses the patient, diagnoses the patient, and then helps the patient manage his symptoms (not cure the illness) the quickest and least painful way possible, while a GP messing around with psychotropics (mental illness drugs) is likely going to do the patient more harm than good.

GP’s, being very conservative in trying to treat something they really don’t understand, have a tendency to prescribe only one drug at a time to a patient with symptoms of a mental illness rather than the cocktail of drugs needed to combat all of the person’s symptoms.  They don’t know how the mental illness drugs interface with each other, and  they’re afraid of doing the wrong thing.  So their one prescription drug usually does little or nothing to help the mental patient.  In fact, sometimes the patient gets the (wrong) impression that a particular drug isn’t working for them at all when the real problem is that the supporting drugs are missing from the cocktail.

A good psychiatrist gives the patient confidence that there is no problem that is insurmountable. He has “been there, done that” so there are few surprises. And when there is a surprise, he knows how to trace the cause so he can find a solution. The average person has no idea how much of a comfort this is.

A good psychiatrist gives a specific timetable of how long a drug will take to kick in. In my own case, upon my discharge from a mental hospital, my (new) psychiatrist told me straight up to expect several months worth of bad side effects as the drugs built up in my system. He said “give me two months” to get the side effects under control. Not gone, but under control. So I had an end in sight. I could put up with the terrible side effects for two months, whereas I couldn’t do it for an indeterminate span of time. In fact, some of the side effects were so bad that had I not known how long they would last, I would have discontinued my meds (as many people with mental illness do) rather than face a potential lifetime of those side effects.  A good psychiatrist will help keep the patient on his medication so that the medication can do its job.

Having to manage with a broken leg for a lifetime is completely different than having to manage a lifetime living with the symptoms of a mental illness. How long can you stand having voices constantly talk to you before you want to jump off a bridge just to get away from them?  How long can you stand to see terrible pictures when you close your eyes before you want to die to get away from them? The psychiatrist’s  reassurance that all problems are fixable puts the patient’s mind at ease. Whatever the problem, I have confidence that my psychiatrist, Dr. K, can fix it.

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Comments»

1. rach - January 27, 2010

I so so so sooooooooooooooooooooooooooo agree.
Sometimes I wonder why I go back week after week to see my psychiatrist. This pretty much sums it all up.

2. HB - February 21, 2010

It sounds like you got not just a good psychiatrist, but a great one! They are, unfortunately, not as common as they should be. I’ve had my share of bad psychiatrists 😦

People do need reassurance, hope, and expertise. It sounds like your doc understands both the psychological and medical aspects.

Very interesting blog to read! I’m glad I found it and will link it to mine shortly.

HB


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