What is Psychiatry?
Psychiatry is a challenging field. Not only do we lack objective tests or measures of "mental illness," but the boundaries of what we call "illness" are expanding. Even professionals disagree on what constitutes psychiatric disease. As a result, patients are frequently given diagnoses or labels which divert attention from what led to their complaints in the first place.
To make matters worse, leaders in the field of psychiatry (as well as insurance reimbursement policies and the pharmaceutical industry) have given most psychiatrists the impression that medications are the most effective interventions we can offer. While medications may have profound positive effects in some individuals, they may also cause harm in others.
How do I Practice?
My personal philosophy is that illness is individually defined. A person will engage in—and therefore benefit from—treatment only if he or she believes that a problem exists in the first place. In other words, only by recognizing that something might be “broken” can one set out to “fix” it. Medications may be a part of this process, but are best used judiciously, safely, and (if at all possible) on a short-term basis.
As a psychiatrist, I first work with my patients to help understand the situation which brings them to my attention: How do they see their condition? How did it arise? Do they believe that they can get “better” (in however they choose to define that term), and have they exhausted all resources to achieve that goal? Do they truly need help, and are the tools of psychiatry capable of providing the help they need? Can I learn something from the therapists, counselors, or other individuals involved in their care?
Secondly, I work with the patient—and others involved in his or her care—to design a treatment plan that attempts to achieve his or her self-identified goals, and sets out a plan of action to take the necessary steps. Sometimes this plan includes medications, other times different therapeutic interventions. Sometimes a higher level of care (such as hospitalization or long-term rehabilitation) is most appropriate. At times the treatment can be brief, lasting only a few weeks, while at other times a lifelong treatment and recovery plan is necessary.
Whatever the situation, human suffering deserves the attention of a professional who is skilled in the assessment, diagnosis, and treatment of conditions that prevent us from living to our full potential. That professional must also understand that each person’s goals—each person’s “potential”—are different, and the unique needs and desires of each person must be addressed. This is the way I believe psychiatry should be practiced, and I welcome you in your search for a better life.