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Misconceptions About Psychiatrists

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People are stupid. No offence.

I've lost count of the number of times that I've been met with the phrase "Can you read my mind?", when I've told people what I do for a living. Recently in a phone shop I replied, "Yes, I can. It seems to me...you're an idiot!" (To myself, in my head).

In my defence - he was.

But of course, to him, I said "No, I'm afraid I can't."

Maybe it's my over-inflated ego and my grandiosity about working within this particular field, but to me it seems remarkable how little the general public knows about psychiatry and psychiatrists. They say one in four people will suffer from a mental disorder within their lifetime. Only a miniscule proportion of the population need cardiac surgery in their lifetime, but everybody knows what a heart surgeon does. Right?

There are several thousand psychiatrists and trainees working in the UK today, yet their function seems to remain ambiguous and mysterious.

Here are some misconceptions which, like they bother me, probably get on their nerves.

We Are Posh, Old And Have Beards

Cheers Frasier!

Not only do I personally feel this show is dull and over-acted, with obvious and predictable jokes, but it has dented the image of a generation of psychiatrists. Other films, such as Good Will Hunting also reinforce this stereotype. Very few of us are pompous, bespectacled and sloppy. A trainee psychiatrist can be as young as 25. Amongst my colleagues, facial hair is sparse, and well-kempt. I also refute the claim that as a professional body, psychiatrists are boring. Within my career I've worked along side colleagues with a range of personalities and interests including a novelist, columnist, a stand-up comic, a part-time rapper and a lead singer of a punk-rock band.

We Tell You To Lie On A Couch And Ask You About Your Mother

This Draconian image is outdated. I think part of the problem is that the distinction between psychotherapists, psychologists and psychiatrists is ambiguous. Psychotherapists specialise in long-term, regular-talking therapies, which occasionally may examine patients' childhood and impact of early experiences. Psychologists also analyse personality traits, and use talking therapy, but often in psychiatric wards, and usually are more flexible in their format.

Psychiatrists are medical doctors, who specialise in treating mental illnesses after medical school. Unlike psychotherapists and psychologists, they can prescribe medication, treat physical complications, and in extreme circumstances, detain people against their will.

Generally, psychiatrists oversee more people than the other two professions, and therefore have less time to spend with each individual patient, and may have to delegate to a Multi Disciplinary Team (which may consist of junior budding psychiatrists, nurses, social workers, and psychologists).

If my office was big enough for a couch, and I managed to stealthily bypass the Health and Safety hurdles, I would use it solely for taking siestas.

We like To Lock People Up

No. Men in white coats don't try to take you away.

For a start, doctors rarely wear white coats nowadays, due to infection control protocols. Psychiatrists certainly don't. Yes, of course people do need to be detained in some circumstances. In contrast to what used to happen historically, this action is never undertaken flippantly.

A psychiatrist has to have several years of experience, two good professional references, and meet other specific qualification-based criteria before they can be "Section 12 approved". Only then can they apply for somebody to be detained. After this application is made, a completely independent senior Social Worker who works for the borough must assess the patient in the company of their own independent Section 12 doctor, to uphold the section under the Mental Health Act (created in 1983, but recently updated in 2007).

It must be proven that the patient has a mental disorder and detention is necessary to alleviate suffering or prevent deterioration of health, and/or for the safety of themselves or others. In principle, patients should be admitted into the least restrictive environment, and their views and wishes should be accommodated as far as is feasible. There are other safeguards within this process, including reviews by independent tribunal (consisting of a psychiatrist, a solicitor and a layperson), during which patients and their relatives are invited to present their case to the tribunal, who have to decide whether or not to uphold the section.

Basically, it is a long intricate process, which patients are invited to appeal against, and independent experts, some of whom are non-psychiatrists, have to review to make sure it's fair.

Psychiatrists Drug People Up

I'm not proud to say that in yesteryear the treatment of some mentally ill patients was barbaric. But then again, history is polluted with other such atrocities within institutions, as we all know. Psychiatry has learned its lessons and moved on. People used to be locked up, medicated and even displayed in zoo-like asylums for entertainment. Over-sedation was a tactic used to control unusual or unacceptable behaviour.

Yes, of course some medication is necessary to control various symptoms like severe depression, hallucinations and delusions. This can relieve thoughts and feelings that torture sufferers. It can keep them and those around them safe by quashing violent impulses. In extreme circumstances, patients can lack insight or be too confused to consent to treatment, so these medications are given against their will. This is done to improve their quality of life.

However, far more frequently, patients are involved in the decision-making process and informed about medications in advance of taking them. A good psychiatrist should regularly discuss medication with patients and review dosages, the type of medications prescribed and potential side-effects to optimise treatment.

"I Bet You're Analysing Me Right Now."

I bet I'm not.

I've been told this many times along with "I'd better be careful what I say around you." I usually shrug and smile back inanely. I'm probably thinking to myself, "Sorry mate, you're not really that interesting."

My speciality is Forensic Psychiatry. Many of my patients have had horrific childhoods, been involved in high levels of lifelong criminality, had severe mental illnesses, have serious drug and alcohol problems, and have committed several violent offences, including murder. After analysing and dealing with these characters all day, it's unlikely I'm going to be stimulated by Average Joe, his mundane background, and his mediocre chat.

Also, if I was an accountant, I would not automatically try to calculate a person's tax return after meeting them in the first time, socially. If I was a dentist, I wouldn't be voraciously eager to examine a stranger's mouth. If I was a gynaecologist...well, you get what I'm trying to say, right?

Anyways.

I like my job. The vast majority of patients have fascinating background and intricate psychopathology (that's clever-talk for psychiatric symptoms). It's still a job, though. It's doesn't permeate into every level of my life. But for every interesting patient I encounter, there's a presumptuous buffoon who has no idea what psychiatry entails and what we do.

But maybe I'm being harsh. Maybe it's the profession's fault for not explaining and advertising ourselves and our roles well. (Though the media hasn't exactly portrayed us in a positive light).

Maybe I can make a small difference. I can start with these blogs. I could write about psychiatry for days on end, and I have plenty more to say. It's all about communication.

Which reminds me - I never did figure out why the guy in that phone shop gave me a tariff that was so much higher than other people I know on a similar contract. Maybe he could read my mind...

Around the Web

Psychiatry and Psychiatrists - Health - The New York Times

Royal College of Psychiatrists

Mental Health Information - Royal College of Psychiatrists

Private psychiatrists in the UK

King's College London - Institute of Psychiatry

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