What’s Up Doc?

Seeing the Psychiatrist
By Bessie

When he smiles at me, I feel elated. When he frowns, I’m terrified. I feel like he has the power of life or death over me and I find it hard to tell him who I really am because he doesn’t really want to know, he just wants to find out what symptoms I have so he can medicate me.

When Freud started the practice of psychiatry it was known as ‘talk therapy’. But now there is no talking. Not for me, anyways, because I am a chronic case. Perhaps the patients that have had an acute episode once in their life get to talk and receive feedback. This is the crucial element that is missing today.

I have been blessed by being allowed to talk to a psychologist in group therapy, but the nature of psychology is not the same. And today’s psychiatry is no longer the same as the historical function. It is merely a question of medication.

I know psychiatrists are under a lot of pressure and often feel rushed and stressed by having to decide which of the many medications on the market are right for a particular patient, but sometimes I want to cry out ‘please talk to me! My future is in your hands! Perhaps you could say something that worked to alleviate my anxiety as much as a pill would’.

If strange behaviour was attempted to be understood instead of discounted completely, it might be a better form of therapy. Too often when a patient pours out his soul, instead of receiving verbal feedback, he just gets an injection. Psychiatry demands verbal feedback, this is the latest ‘miracle cure’.

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It aint my fault
By Yehoshua

I feel I’ve done
What I’ve forgotten
Some thing bad, for sure, again
But that’s OK
Though I feel rotten
It ain’t my fault
I’m just insane

My pills, although they taste atrocious
My mind, though it is full of fluff
Is not fixed yet, is in psychosis
Though heart be made of sterner stuff

And ‘though I see straight through the liars
of mine own mind, mine own deception
I still feel the pains and briars
That I’ve forgotten aren’t my conception
O’ take me not, o’ G-d of mine,
O’ one who made me, to whom I yearn
For I am full of strong desire
To live for life’s still moving turn

No fate yet holds me, I am not dead
For all of evil’s vain attempts
From death’s deceiver, I take my fate
And treat it with mine own contempt

I’ll take my life in mine own hands
And live it to the full degree
And not yet death shall take my soul
And not yet death shall conquer me

And not yet life shall flee my lips
And not yet sight mine reason lose
And still this diseased brain of mine
Won’t conquer me, if I but choose

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The relationship between the patient and psychiatrist

By Dennis

The relationship between the patient and psychiatrist is a complex one. Usually, when one seeks psychiatric help, one is not in the best frame of mind to make a rational decision. Therefore, one may not choose the right psychiatrist for oneself.

In my experience, I have sought professional help at a time when I was in a bad emotional state. I have been hospitalized twice since I have been in Israel. I felt as though I was in a prison. Due to financial reasons, I think that the main purpose of the psychiatrist was to get the patients to a level where they could be discharged. I felt that I was not treated as an individual, but as part of an assembly line.

Once I was discharged from hospital I was referred to a doctor in the public sector – Ministry of Health (Misrad HaBruit). I think that the quality of treatment in all areas of medicine is poor. Generally, the psychiatrist has ten minutes to work with the patient.

Eventually, on the recommendation of my psychologist, I now see a private psychiatrist. I have been fortunate to receive the financial support which allows me to use a private physician. However, I realize that not everyone is so fortunate.

“Have a heart that never hardens, and a temper that never tires, and a touch that never hurts.” – Charles Dickens

Great Expectations….which may need some adjusting

By Elisabeth

When feeling vulnerable, desperate and in need of help we all have a tendency to look to one person, one profession, one pill, one comforting sentence, one solution to grant us the serenity to believe that our suffering can be alleviated. While this may be a common expectation of, let’s say, ones psychiatrist I think we sometimes forget that their capacity is limited and that they, unfortunately, cannot be our “end all be all”.

An important distinction that needs to be made is the difference between psychiatrists and psychologists. This is a common mistake made by individuals, patients and even professionals. The term/title is often used interchangeably which is critical error, in my humble opinion. Because of our collective hopes as clients, as concerned family members, and as society in general our expectations become deeply misguided as per what these professionals should be doing for us.

Just to set the record straight – a psychiatrist has a degree in medicine and has specific training in assessment, diagnosis, treatment and prevention of mental illness. Psychologists receive graduate training in psychology and pursue a PHD in psychology, (or in some countries philosophy) clinical psychology or counseling. Moreover the title ‘psychologist’ can often be applied to counselors, therapists, mental health care professionals, and EVEN applied to….Social Workers (with proper certification). Both professions are licensed, but the final, major distinction is that psychiatrists have the almighty power of prescribing DRUGS!

I think this is the defining factor where the role of dependency falls into place. It may serve to explain why we develop this complex set of emotions towards psychiatrists and the hope that they can be our all-in-one mentor, doctor, empathizer, and friend. The dependency issue is not assisted by the fact that (non-privatized) psychiatrists tend to have extremely limited time to spare when it comes to discussing your overall mental health. Moreover, as a mental health worker trying to contact a client’s psychiatrist and actually succeeding at getting the doctor on the phone, the conversation is typically over before it’s even really started.

Possible solutions to this conundrum from a mental health worker perspective would be greater patient inclusion in their treatment plan and a provision of psychosocial education re; diagnosis, medication, prognosis etc. I have had clients who have never received a proper explanation of their diagnosis, and in extreme cases were not informed of their projected diagnosis due to the assumption that it wouldn’t have made a difference to them anyways. The amount of clients who have had multiple diagnoses are a dime a dozen. If they were provided with the tools to better comprehend their diagnosis it would mean a greater understanding of their symptoms and hopefully more accurate medication. I would like to end by saying that I personally feel medication is an integral aspect of one’s recovery, but it is important to acknowledge the fact that medication only goes so far. I strongly vouch for a two-tiered system of medication and complimentary treatments such as therapy, social support, creative outlets, music, art, sports, community, meaningful work opportunities and the integral goal of belonging and understanding. All of these aspects attempt to encompass the human spirit and holistically nurture the soul.

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8 Responses to What’s Up Doc?

  1. Pingback: Psych-what? Finding treatment professionals who work for you. | Where I Stand

    • Thanks so much for sharing your brave and insightful blog with us! It sounds like we are looking to achieve similar goals; break stigma, provide education and spread hope. Looking forward to hearing more!

  2. Judith Ronat M. D. says:

    Hi everyone,

    I am a psychiatrist, an old fashioned one, who dislikes medication, and I prescribe it only as a last resort! I listen to my patients, and I talk to them, and when possible, I am also their psychotherapist!

    I would like to respond to some of the points made in this blog.

    Firstly, a psychiatrist is a medical doctor. His first goal should be to check whether the examinee’s symptoms are caused by a physical disease. Often, diseases of moods are caused by endocrine problems. Tiredness can be caused by anemia, by sleep apnea, among other things. After the psychiatrist has referred those patients who need treatment for a physical disease, he is then left with those whose primary problem is emotional. Many of these patients can, and should, play an active part in determining what kind of treatment they want and need. If they want and need a medicine, their input will add the placebo effect to the pharmacologic effect.

    Second, in my opinion, the contact between the psychiatrist and the psychotherapist is extremely important. If they don’t have time for each other, it is best to try and find a set-up where they do, and/or to lobby for more contact between them!

    I think this blog is very important. I am grateful to have learned about it. Keep up the good work.

    Judith Ronat M. D.

  3. Verne Gruber says:

    Elisabeth: I like your emphasis on combining medication with other strategies including talking therapies, social interaction, career training, music, sports etc. Bessie lamented the fact that psychiatrists don’t have enough time. This is true, but under the overall supervision of a psychiatrist or qualified therapist, good exposure to non-clinical activities and community programs can go a long way to contributing to the patient’s recovery and ultimately their happiness.

    • Carmel says:

      I have found the above comments and thoughts very interesting and meaningful.
      As an occupational therapist who has specialised in the area of mental health for many years in the UK and USA, I have found that the types of programs/activities that OTs offer, can be very helpful. We are trained to facilitate groups or work on a one-to-one basis in many different areas, such as social skills, arts and crafts, activities of daily living, community re-entry programs, physical activities, music, preparation for returning to work, life skills, etc. We work with both acute and chronically ill patients in hospitals, day treatment centers, community settings, prisons, schools, nursing homes, senior residential facilities, etc.
      The client is assessed initially in order to identify their particular needs, and might describe what he or she feels are their strengths and weaknesses, and they might also prioritize the order in which they would like to make changes. They might be told that they are the key member of the treatment team, (psychiatrist, psychologist, nurse, social worker, and occupational therapist) and that they can tell best how they are progressing. Whenever possible, increasing self awareness and understanding should be of primary importance. Specific short and long term goals are identified, and there is regular assessment of progress. Some typical general goals could be improving self esteem, feeling more comfortable in social situations, decreasing anxiety, alleviating depression, coping with every day stressors, developing hobbies and/or interests, etc. Some specific goals could be coping with shopping, cooking, child care responsibilities, medication compliance, or managing to hold down a particular job.
      The client would participate in variety of appropriate activities that would enable him or her to move closer to their particular goals.
      Is there anyone who would be interested to develop this kind of program here in Israel?
      Please contact me.

      • Hi Carmel,
        Thanks for your thoughtful comments as well. In terms of a similar program to what you suggested, my organization is funded by the Israeli Health Ministry which has a branch of rehabilitative mental health services entitled ‘Sal Shikoom’ (which translates to ‘rehabilitation basket’ essentially). This ‘basket’ offers access to mostly all of the various types of supports and services which you mentioned. It may be carried out in a different professional way here but it strives to encompass independent living in the community, work/supported work opportunities, social work and supportive counselor intervention, social interaction/aid, various financial/social aid.
        Look forward to hearing more from you in the future. Thanks for following the blog.
        Elisabeth

  4. Leah Abramowitz says:

    This is a very important contribution to the interaction (or lack of same) between patients and psychiatrists. The plea heard again and again is for a more human touch, repore and empathy.
    Leah Abramowitz
    Geriatric social worker
    Nefesh Israel co-chair

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