What You Should Never Let Your Psychiatrist Do
So what should you never let your psychiatrist do? Well, the answer is surprising, as the answer is related to the primary reason why patients go to psychiatrists in the first place…to obtain a prescription for medication treatment of a mental disorder. A patient should never let their psychiatrist prescribe medications without first formulating a comprehensive treatment plan.
Unfortunately, psychiatrists are increasingly relying on DSM-IV (now DSM-V) checklists and cookbook medicine. First, they go through their checklists and check off what signs or symptoms are present, and if they meet the minimum criteria for a particular syndrome, a classification (diagnosis) is given, and a medication is prescribed that address the classification (diagnosis). For instance, if the patient meets criteria for major depressive disorder, then an SSRI (Selective Serotonin Reuptake Inhibitor) may be prescribed, or if schizophrenia is the classification, then an antipsychotic may be prescribed.
Here`s the problem…when psychiatrists are focused mainly on the prescription of psychiatric medications, then you are getting substandard treatment. 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 walking out of your psychiatrist`s office with only a prescription in hand, 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 problems/solutions?
Let me elaborate 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, what about the psychological causes of the anxiety and depression, where one has constant worries, feels no one loves them and has low self-esteem…is a pill going to address these psychological problems? Of course not…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…obviously, these are things that a pill cannot cure.
In addition to the biological and psychological contributors to mental illness, there is also the social realm. Anxiety and depression can be triggered or worsened by social factors, 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, how can a pill address these problems? Again, 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. A pill is only part of the solution.
Unfortunately, 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, we have no objective tests to confirm our clinical suspicions. As such, psychiatrist must rely on comprehensive clinical interviews and must devise comprehensive treatment plans encompassing the biopsychosocial model, coming up with formulations which must be continually tested, and if a treatment course is not effective, then to come up with new formulations and eventually test if these new formulations are correct. Such is the state of modern psychiatry, which requires comprehensive treatment plans and dynamic formulations and testing of the formulations. So if a psychiatrist give you a diagnosis and focuses mainly on the medication prescribed, then one needs to question their psychiatrist regarding the complete treatment plan, which also includes 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. No brain scan or blood test will confirm the psychiatric diagnosis.
Fortunately, there are psychiatrists out there 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 in a short amount of time, 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 $200 per hour 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.
So the next time you see a psychiatrist, don’t let them only focus on medication treatments. A person who may be suffering from a mental illness needs a comprehensive, biopsychosocial treatment plan. Fortunately, psychiatrists utilizing this approach are effective, and no other specialty can be as effective for mental illness as a psychiatrist who wields this approach.