So what really is the difference between a psychiatrist and a psychologist?

Greetings all, 

I bet as fellow psychiatrists you are asked this all the time, or maybe not. I always start my session with new patients targeting this to attempt to and debunk any stigma and myths they invariably have about us. The stock standard answer from the new patient is that 'you prescribe drugs, psychologists don't'.

 What a shame that after over a hundred years, post collaborations between Freud and Jung who later parted ways as the genesis of psychiatry and psychology was forming, we still have to explain to patients who we are and what we do. In stark contrast, if a patient presented with a broken leg to an emergency department, they would demand to see a doctor, not an allied health professional fully qualified to assist with rehabilitation. Yet for some reason psychiatry is not recognised as a medical specialty amongst lay people in 2014, and we still need to 'sell' ourselves to those who are referred to us. For those of you reading this and disagree, I suggest you begin your sessions the same way and see what they reveal. Reality ain't pretty. 

There are so many reasons why psychiatry and psychology are two different disciplines that share similarities and should complement each other. Go read a standard text and work it out. In clinical practice, although I incorporate my own mix of pharmacological and psychotherapeutic approaches, I have a niche of psychologists whom I refer to constantly to request their guidance, and deliver their expertise for patients we share. In private practice it is a lovely nurturing model that the public hospital system with all its rhetoric and useless catch phrases never accomplish when they refer to the use of a multidisciplinary team. Where would I have ever learnt about schema focused therapy in my training, yet how many patients have I referred to psychologists for this expert type of therapy that have resumed their lives, better than before with a collaborative approach between psychiatrist, psychologist and GP? Any patient, for which there are so many, with childhood trauma, benefit so beautifully with this approach and I have learnt so much from my psychology colleagues.

But here is the disparity. Last week, I met a psychologist who was keen to work 'collaboratively' with me. After about 10 minutes he was keen to impart his ideas that in about 20 years, psychiatry would be a dying profession, and by then psychologists would be able to prescribe medications. In his eyes, psychiatry was the path of last resort for patients with mental illness, as psychologists were much more expertise when it came to understanding the mind and brain. He had little time for doctors in general and psychiatrists in particular who prescribed medications indiscriminately, and didn't seem to appreciate what psychiatrists could offer. Yet he wanted to work with me and share patients. If I could refer them to him. Gee, thanks, but I chose politely to decline the offer. However, I was left thinking, was his view reality based on his interactions with our specialty or was it skewed? It's easy to argue the latter when defensive. We ain't surgeons, we don't fix almost AMI's and death amongst our patients is taken on as personal failure. Our work is not glamorous, but was he frustrated about our resistance to work together collaboratively, or was he trying to claim our turf bestowed with our medical registration and specialty training?

And then the second disparity. A new patient referred to me and in the throes of engagement with our fortnightly sessions. Towards the end of the second session she felt compelled to talk about her conflict. Not about her life, her family, her chronic illness or her existence. No, her conflict was she didn't see me as a psychiatrist. She asked me to label what was wrong with her and I replied by saying that labels were not always useful, getting to know people was much more helpful. I reassured her that I was still getting to know her and for her to feel comfortable with me. But her feedback was compelling; she stated I acted more like a psychologist as I was more down to earth and easy to talk to. How did she form that opinion? Where did that come from? In her early 20's and without any formal psychiatric history, this was her opinion. 

What is psychiatry getting wrong? Why do we have to constantly defend what we do? Are we going to be obsolete? I welcome you unabashed, candid views...

As always,

Helen

Please tell me this is not happening...

Ok, I haven't worked in the public mental health system since 2009. OK I might be misinformed. But I am hearing more and more from colleagues that a reduction in staffing in public hospitals is leading to increased use of major antipsychotic medications to sedate patients, so they require less intensive support and care. Known as 'chemical restraint', this method is being used over safer methods during the acute period a patient may be agitated and require transportation. Now, anybody who has not witnessed first hand how unwell and distressed patients with acute mental illness can be may find this diffiicult to comprehend. But doctors and nurses are duty bound to ensure they keep patients safe from themselves and others until better. The safest way is to use trained staff to calm patients, proivde one on one support and supervision, in a low stimulus environment. The same goes for patients who are agitated and distressed from head trauma or brain infection as well. Hospitals should be able to rely on teams of trained staff to use their expert skills to contain patients, thus minimising the need to use antipsychotic medications to achieve this.
However, the word on the street is because of staff shortages and more acuity in patients, the use of chemical restraint is becoming more routine in situations where patients need to be transported or contained. Chemical restraint is achieved by injecting medications used for illnesses such as schizophrenia.
So, what happens to patients when they are given cumulative doses of major antipsychotic medications? Well, they may experience respiratory depression, ie unable to breathe effectively, and may end up with pneumonia. They may experience severe side effects of potent medications, particulalrly if already on regular doses of medications. And when chemically sedated, they can't alert anybody that they may be experiencing symptoms of this.
In no way am I blaming the staff who do a superb job working with patients who are very unwell. I am blaming a public health system that looks at dollars, cuts brutally and without consideration, and I feel for the vulnerable patients with acute mental illness that suffer as a result.

Fame is not a vaccine for depression

This week has been confronting for most who watch popular or social media. We have woken to the news that celebrity olympian, Ian Thorpe, has declared he is being treated for depression and other conditions, and whether due to depression or not, the world has lost Philip Seymour Hoffman, who, most importantly, was a father of 3 young children. In a society so accustomed to perceive we know people we have never met, to 'follow' and to 'like' complete strangers we seem to be affronted that we are not aware celebrities are in pain or struggling. How many of my patients tell me they would not consider informing friends they are seeing a psychiatrist, let alone reveal they are depressed, anxious and perhaps entertaining suicidal thoughts? If they don't feel comfortable, then how can we expect those in the spotlight can until it is way too late?
Is it living in the spotlight that makes those vulnerable to mental illness fall victim to it? Or is it that they are just like everybody else, with the same chances of developing what are common disorders such as anxiety and depression? And surely, as a society we must remember we don't really know anybody very well, particularly those we like to think we know because we follow them.