I’m a psychiatrist, despite many friends thinking I’m a psychologist. No harm done – I’ll use the opportunity to describe an often misunderstood difference. Most people think the only difference is that psychiatrists are M.D.s (endure medical school and residency as physicians), which means psychiatrists prescribe medication.
But there can be more than just that. Both fields are internally diverse, with various content and qualities of training, adherence to different theories of etiology and understanding of human nature. Within both fields there are some who become more clinical, and others more research based. I know psychiatrists who are more therapy-focused than psychologists and vice versa. There is much more overlap than difference, though the fields are trying to separate themselves (in part due to health insurance and influences of policy).
Psychiatrists are formally trained to help the full spectrum of clients – from “worried well” to most severe. They have been through medical school, residency, and oftentimes a specialized fellowship. What’s gained from medical school is more than an ability to prescribe. Hopefully, good medical training builds a professional ethical foundation on which to allow the most seriously ill, vulnerable and often terminal patients, to be the primary responsibility of a physician. It’s a great responsibility that turns many away, and others toward, the field. Physicians learn to take a special ownership or responsibility over their patients.
Good psychiatric training is based on an understanding of people from multiple influences: biological, psychological, and social/cultural, as is taught from the beginning of medical school. However, some psychiatrists lean on one influence more than another based on interests, personal beliefs, or the nature of one’s training program.
Since psychiatrists are trained to deal with the full spectrum, including the most emergent and severe patients, and are trained to take a multi-etiological approach to understanding the patient, they can also be the umbrella that pulls multi-disciplinary information together – the biological or medical influences, in addition to individual psychological, and societal/cultural forces at play.
Personally, my training in the midwest, east coast, and west coast, gave perspective about how psychiatry is taught and how the role of the profession viewed. Some cultures focus on medication for treatments, and others on therapy and the understanding of interpersonal dynamics and experiences for healing.
To be clear, there many are psychologists trained to take care of very difficult cases, take full responsibility for patients, and lead clinical teams. It’s hard to understand what the field of psychiatry truly is, until practicing. Even in my medical school rotation, I didn’t understand what being a psychiatrist really was, though I had a good understanding of what pediatrics and surgery were about. There’s more uncertainty inherent in this field (at the moment), as our research and practice constantly change, as evidenced by the DSM-V proposed revisions.
Culture highly influences the role of a psychiatrist. The field of psychoanalysis in Freud’s time, was limited to only M.D.’s, and was thought highly intellectual. But some of my best supervisors were psychology analysts. Currently, the culture of mental health care is such that reimbursement is so low for a psychiatrist to do therapy that psychiatrists who are truly well-trained in the biological, psychological, and social understandings of patients, are forced to do only 25-minute “medication management” sessions. This, despite the research that integrated (both medication management and therapy) by one person is more cost-effective and efficacious than split care (a therapist and separate person for medications). In my opinion, the training programs and thus, nature of “what a psychiatrist is,” is highly influenced by the culture of health care at the time (pharmaceutical and health insurance company, and policy/legal influences).
I’ve had excellent psychologists, social workers, and psychiatrists who taught me therapy. I’ve also learned neurobiology from psychologists and psychiatrists. I sought out the best, and found they all had different degrees after their name. To truly understand the difference between a psychologist and psychiatrist would mean choosing one and getting to know the individual, and how they practice. For me, I no longer feel a strong affiliation to the professional title. I’m an advocate, and that’s the most comfortable title that makes use of a full range of skills.
What are your experiences or thoughts about psychologists vs. psychiatrists, and the role of medication vs. talk therapy for healing?
As a now retired physician. born in Indonesia, being very fortunate to be able to study medicine in Europe after finishing high school, after graduating als a doctor not really being able to return “home” since the 1965 Soeharto coup made life “unhealthy” for the chinese ethnic minority, I very much admire your dedication in helping the underpriviliged. I wasn’t brave enough to return and try to do something at the grass roots level, as one of my friends did.
In the past, in the The Netherlands most people were not insured for psychologist’s consultations (now they are, but still a big co-payment needed), so a lot of psychologists worked under or with psychiatrist who were in the system.
To whom did I refer the patients to, then?
Roughly speaking, people with inability to cope with life problems, workaholics with problems due to that, phobias, problems dealing with unfinished mourning, stressful life events and the like I refered to our psychologists, while people with deep depressions likely to need medication and psychotic people were refered to our psychiatrist. Substance abuse was and still is treated in specialized clinics or by specialized outpatient units set up by the public health authorities.
I think yoiu do a lot more..
Keep on the good work!
So fascinating about your life course. It speaks to the influence of insurance and payment systems on how we treat people. Unfortunately it also affects training, where many psychiatrists may be at risk for not learning how to treat various psychological issues. Sounds like you have a lot of experience and teaching to offer!