Seeing the Psychiatrist
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’.
It aint my fault
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
The relationship between the patient and psychiatrist
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
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.