One Question To Always Ask Your Psychiatrist

There is one question to always ask your psychiatrist: do you ascribe to the biopsychosocial treatment model? Why is this important? Unless your psychiatrist ascribes to the biopsychosocial treatment model, then the treatment will most likely be incomplete. The problem is that psychiatry is becoming more algorithm driven, and psychiatric assessments are basically checking off lists of signs and symptoms, and if criteria are met for a particular disorder, then a classification (diagnosis) is given, and then one looks on the algorithm as to what to prescribe next. The problem with this approach is that it is primarily focused on the prescription of medication, and the “other” parts of treatment are either ignored, or contracted out to an outside therapist, otherwise known as split treatment. What then occurs is that the treatment is incomplete, and the patient only has a partial response or no response to the incomplete treatment, and the patient continues to suffer.

When psychiatrists are focused mainly on the prescription of psychiatric medications, then substandard treatment is given. In order to treat complex, multifactorial illnesses such as mental disorders, one needs a comprehensive treatment plan that addresses biological factors, psychological factors, and social factors (Carandang, 2009). This is termed the biopsychosocial model as first coined by Engel (1977). The problem with your psychiatrist focusing on medication treatment is that it is only a part of the solution and is an incomplete solution. Sure, SSRIs block the reuptake of serotonin so that more serotonin is available at the post-synaptic cleft of neurons in patients with depression or anxiety, but this is only a biomedical solution, and will only address part of the problem. What about the psychological and social domains?

Elaborating further on the biopsychosocial model, the biomedical realm describes the biology and pathophysiology of the illness. As described above, depression and anxiety can be viewed at a molecular level as a problem with serotonin depletion at the post-synaptic clefts of neurons, and SSRIs can address this and regulate serotonin levels in the brain to normal levels, decreasing the symptoms of anxiety and depression. However, the psychological triggers/perpetuators of the anxiety and depression continue, where one has constant worries, feels no one loves them and has low self-esteem. A pill is not going to address these psychological problems. A patient with anxiety and depression who has constant worries, negative thinking and low self esteem needs help with their psychology. They need help thinking differently, to address cognitive distortions, to find evidence for their thoughts, to find validation in their strengths.

The social factors also need to be addressed, in addition to the biological and psychological factors in mental illness. Social factors can trigger or worsen anxiety and depression, such as relationship problems, loss of loved ones, financial problems, legal problems, job/school problems, cultural problems, trauma/abuse, just to name a few. If one has lost a loved one, or is being harassed at work, social interventions are needed. When dealing with grief, or dealing with stress at work, one needs help talking through the grief and guided through the process of bereavement, and one needs help going to their human resources department or union to help one deal with harassment at work. Medication treatment is only part of the solution.

Psychiatric diagnoses are inherently fraught with subjectivity, and thereby may not be valid, should a rigorous scientific method not be instituted. I opine that the biopsychosocial model is that rigorous method that should be incorporated into all psychiatric assessments and treatments (Carandang, 2009). Psychiatric diagnoses are clinical diagnoses, in which there are no objective tests to confirm if the clinical diagnosis (obtained solely through clinical interview and history) is correct. Other medical specialties have the luxury of objective tests to confirm their clinical suspicions. In psychiatry, objective tests are not available to confirm our clinical diagnoses. As such, psychiatrists must rely on comprehensive clinical interviews and must devise comprehensive treatment plans encompassing the biopsychosocial model, coming up with formulations/hypotheses which must be continually tested. If a treatment course is not effective, then new formulations/hypotheses are needed and eventually these new formulations need to be tested to deduce if they are correct. Such is the state of modern psychiatry, which requires comprehensive treatment plans and dynamic formulations and testing of the formulations in order to have scientific validity. So if a psychiatrist devises a diagnosis and focuses mainly on the medication prescribed, then one needs to question their psychiatrist regarding the complete treatment plan, and as their problems also span the psychological and social realm, in addition to the biomedical one. If a psychiatrist does not give a comprehensive biopsychosocial treatment plan, then one has to question the validity of that psychiatric assessment, given there are no objective tests to confirm clinical suspicions in psychiatry.

Fortunately, there are psychiatrists that ascribe to the biopsychosocial model, and these are the psychiatrists you should seek out for assessment and treatment. Otherwise, any technician can be trained to use checklists and ascertain if someone meets the criteria for a mental disorder. Certainly, training technicians to carry out mental health assessments would be cheaper than the hourly rate a psychiatrist typically charges for their clinical time. However, when a fully trained and experienced psychiatrist utilizes the biopsychosocial model to devise comprehensive treatment plans, no one else can do what they do, which is address the mental illness in a comprehensive and effective matter.

In summary, ask your psychiatrist if they utilize the biopsychosocial method. A person who may be suffering from a mental illness needs a comprehensive, biopsychosocial treatment plan. Fortunately, psychiatrists utilizing this approach are effective and help those with mental illness to recover and relieve suffering.