I would like to think being brought up immersed into a day in the life of psychiatrist has given me an unfair advantage in my career. Waiting in my mother's office at the age of 12 while she visited the wards in the rural sprawl of a large community based hospital for people with learning disabilities, I'd find myself flicking through a large red psychology textbook, continually asking myself the same question: if you can't see mental illness, how can it be there? Yet, I would hear the harrowing stories of people whose lives had been blighted by mental illnesses that would have a profound effect on them and that of their families. Back at home and at school, I would also grow up having a brother with Asperger's Syndrome (a form of Autistic Spectrum Disorder) and whose behaviour was just called "odd" until finally diagnosed in his late 20s. He was part of the lost generation of late diagnosis for this mental disorder. Mental illness cuts across the whole of society. It tears lives apart. Most suffer in silence, behind closed doors.
Most others are not so lucky with having a more complete understanding of mental health. Our thoughts, feelings and emotions are what define us. They are the parts of our personality and behaviour against which we are judged. In 2017, our knowledge of and attitudes towards mental health are still those of fear, ignorance and prejudice. There must be a way forward, but there are some myths in urgent need of dispelling.
What is Normal?
We would probably consider it normal to get angry when things aren't going well, or going upstairs to get something and then forgetting what it was. It is only when things happen regularly and start to affect the way in which we lead our lives, that it ceases to be normal. Again, this might still be determined by what is socially acceptable, but the way in which mental disorders are classified takes this into account. As society changes, how we describe mental disorders changes. There may be some, like dementia, that stay the same. Even then, it may be that we discover new associations, such as the damage done to the brain through heavy drinking or addiction to novel psychoactive substances.
Psychiatry vs Psychology
Think of it this way. The extent to which we experience what are common behaviours, emotions or thoughts can mean feeling extreme anxiety, overwhelming negative thoughts or showing irritability to others. Such emotions and behaviours are often treated by psychologists using talking treatments to change the way we think and feel about ourselves and our interaction with others. These are often referred to as "Common Mental Disorders". When the quality of mental health problems changes, this is where psychiatrists begin to have a bigger role. These may be abnormal beliefs or experiences such hearing voices. We still refer to mental disorders, but mostly deal with severe mental illness such as bipolar disorder, schizophrenia or dementia.
Psychiatrists can treat severe mental illness with medication but can also combine their knowledge and skills as doctors with a broader overview of psychological, social and cultural influences to assess, treat and provide care for people with complex mental health problems. This requires years of training. By the time psychiatrists become consultants, they will have spent between 5 and 6 years in medical school, 2 years as a foundation doctor and at least a further 6 years in postgraduate specialised training.
Psychiatry: Art or Science?
Although medically trained, psychiatrists use the therapeutic interaction of dialogue to bring about improvement in mental disorders. We hear about "craft" specialities such as surgery. Well, words are our craft. How we use them and when we use them can make a huge difference to recovery. We can also use our medical knowledge to look at how physical problems contribute towards mental disorders. In some instances, treating physical illness can prevent or even treat some of the symptoms of mental illness. Looking at the bigger picture means combing both art and science. We could perhaps say that Psychiatry is the Art of Science.
Mental Health Deserves Better
Psychiatrists are keen to change myths about mental disorders. We are also keen to change public opinion through public engagement. Of course, that's the main reason for writing this. The figures on mental disorders may surprise you. One in five mothers suffer a mental disorder during pregnancy or in the first year after childbirth. One in ten children between the ages of 5 and 16 have a mental disorder. One in six adults have a common mental disorder and 1-2% of adults have a severe mental illness. One in 30 adults have drug addiction and one in four older people in the community have a depressive disorder. More people with mental disorders now need more treatment within shrinking resources. This has prompted The Royal College of Psychiatrists to their Manifesto to improve the nation's mental health Five Steps to Fairness
Changing Psychiatry from Cinderella to Princess Leia
Selection into medical school has long been done through choosing the "bright scientist". I'm not saying that's wrong, but we need a better balance, particularly if we want to train more psychiatrists. The number of psychiatrists in the NHS continues to fall, with a 10% drop in those specialising in child and adolescent, as well as old age psychiatry between 2013 and 2015. Ensuring that UK medical schools consider Psychology A-level as equivalent to other sciences and admitting students with Psychology degrees would be a huge step forward and would surely revolutionise the specialty in several different ways. It would improve morale, increase research output and provide a greater critical mass to lobby for changes to mental health funding. It would also help to improve the image of psychiatry and improve public engagement. But we know that we cannot do this alone and needs input from patients and the public to shape our future. That future should be now.