To ask why psychiatrists are viewed in this way

[busyweeks78]

I’ve only ever had positive experiences with them but as a general rule the stereotype seems to be a negative one. Aibu to ask why?

There are lots of papers, including in the Psychiatric Times, debunking the chemical imbalance theory. And the evidence is that anti-depressants only improve symptoms in 20 out of a hundred more patients than would have got better on their own.

I've read a few papers on this too. I've been looking into after several experiences with family and friends who have been put on antidepressants with extremely adverse effects and who have stopped taking them eventually and improved on their own. It seems to me that it really isn't as clear cut as it's often made out.

Also, my American friend who has several different personality disorders according to his psychiatrist, he is so reliant on his medication. His mood changes if he runs out and misses a day but only if he notices. If he forgets to take them because he's just having a busy day, he's fine. If he runs out and is aware of it, his mood drops severely and he starts talking about how much he needs his medicine. I can't help but think there must be some kind of placebo effect at work there.

That's not to say I think there is no place at all for these kind of drugs. I have a family friend who actually has bipolar disorder (I say "actually" as opposed to the time I was misdiagnosed as having it myself as I mentioned in a previous post) and needs his medication badly. Medication also helped a very close family member of mine after she had a severe mental breakdown. But I think they are needed far less often than they are given.

There are a lot of polarised views on this thread, as may be anticipated, but the reality is surely somewhere in the middle. a bit like Brexit . Obviously there are going to be great psychiatrists and some shits ones, just like in any profession, medical or otherwise.

It’s perhaps not helpful to compare psychiatrists to other medics, or other MH professionals. However Psychiatry is not an easy option. The decisions one makes are more nuanced and you don’t just have to follow the fixed protocol for eg treating a chest infection or doing CPR. It takes a lot of skill and experience, as well as exceptional interpersonal skills, so perhaps that’s why some aren’t as perfect as we would like.

And as a psychiatrist in training, you have a shit load of responsibility for medical care of patients. On-call you might be the only person who has much of a clue about physical health in the hospital, so you also have to treat that chest infection and lead the CPR efforts whilst doing all the other stuff.

Way upthread someone compared the training between psychiatrists and psychologists, suggesting psychologists have a higher level of training. Psychology is one of the most popular undergrad degrees in the uk. However there are relatively few places available to do the clinical psychology training so the ones that get a place are the very best. Most of the NHS psychologists I have met have been excellent.

I think it is easier to get a place on a medical degree course without the need to demonstrate such well rounded skills and experience beyond just academic success. So you may get a higher proportion of doctors who are not excellent. However the clinical training is far harder. Being a junior doctor in foundation years is just much tougher than clinical training in psychology. The level of (life and death) responsibility, stress, and working pattern does not even compare. And given that psychiatrists still hold the leadership role (rightly or wrongly) when they are consultants, they continue to carry the burden of risk and responsibility compared to their psychologist colleagues.

We should recognise that we all have a role to play and work collaboratively. We need more psychiatrists and psychologists in NHS services. The best ones work together and also recognise when their colleague in the other discipline may be more suited to help a patient that they are.

I think it is easier to get a place on a medical degree course without the need to demonstrate such well rounded skills and experience beyond just academic success

This is incorrect. There is no medical school in the U.K. that doesn’t care about a potential students well roundedness and experience. Training medics is extremely expensive. They don’t want to make mistakes about who they accept - it’s not fair on anybody.

It’s just my opinion, please try and prove me wrong if you think I am incorrect. 15% of clinical psychology applications are successful. And these applicants have already been filtered as they have completed their psychology degree to the requisite standard. And they all have to have clinical experience and done research and likely publications.

Majority of medical school applicants are still coming directly from school so the expectation of well roundedness and experience are understandably less. In my opinion!

15% of clinical psychology applications are successful

Hmm, no of applicants versus acceptance rate isn't relevant. We have had dozens of applicants for a recent cleaning job..... 🤷🏻‍♀️

I'm not arguing that becoming a clinical psychologists isn't difficult. I know that it is. it was just your comment that it's easier to get a place on a medical degree course without the need to demonstrate such well rounded skills and experience beyond just academic success that's incorrect.

Hilarious that I haven't seen one person mix up the different professions...

Well all the anecdotes about psychiatrists helping them/ their family member 'move on', 'deal with x, y, z' etc are a clue...

15% being successful could be because vast numbers get the psych degree but paid clinical roles are very scarce.

I've read a few papers on this too. I've been looking into after several experiences with family and friends who have been put on antidepressants with extremely adverse effects and who have stopped taking them eventually and improved on their own

Anecdotes aren't really data though. The natural history of depression is that it will likely improve on its own to at least a degree within 9 months or so. So yes, some people will seem to get better "on their own". However the suicide rate in severe depression is around about 11% so to be honest we kind of prefer to treat it rather than just leave people to it. Broken bones also heal on their own, without any medical intervention, but I wouldn't recommend it.

I think psychiatry is just one of those specialties where you can't do right for doing wrong really.

Psychiatrists do have training in talking therapies - it’s mandatory and we have to understand the different modalities of therapy so we refer the right person to the right therapist. Most of us don’t deliver them though - there is a medical psychotherapist role in some organisations but most is delivered by psychology trained therapists.
I absolutely agree medication is not the answer for many people and sadly until the drug companies come up with better that weight gain is a problem for many of the meds but we do support people with this and try to manage this as well as we can. However I agree with decking the halls that medication can be literally life saving and the most common thank you card I get is ‘you saved my life’
We do really try to do our best. I object to the idea I am a ‘failed doctor’ as I made an active choice to be a psychiatrist and undertook years of training and exams to become one. And I absolutely love it - it’s a privilege to be able to help people when they are at rock bottom.

Psychiatrist after psychiatrist failed to relate to my schizophrenic brother. They wouldn’t speak to my mum without him present as he was over 18. He didn’t think he was ill, he thought it was all a conspiracy and not one of them managed to reach him. There’s rock bottom and there’s paranoid and deluded.

I'm so sorry to hear about your brother. Sadly psychiatry is ime very limited. There isn't a pill you can take to cure you of thinking that people are going to kill you. There isn't a pill you can take that tells you you aren't irredeemably bad. All they do is give you pills that sedate you so you give less of a shit and cause less trouble. Sometimes the sedation works to the extent that you can hold a coherent conversation. If you can do that a few times, you might be ok and benefit from talking therapy. But even then you'll be fat and sleep a lot. Probably forever. And then you'll die from diabetes or heart failure or have a stroke because that shit isn't good for you.

But medication can't cure what is termed psychosis, it can't cure what is termed delusion. For fuck's sake it can't even agree from country to country what is psychosis, what is an illness, and what is not, never mind actually get to the heart of human distress and trauma.

In France, twenty two miles across the channel, the diagnostic criteria are completely different from those in the UK. In Italy hardly anyone is in hospital. They just make this shit up according to what seems to fit the country they're in and sedate people, take away their health, lock them up and ultimately kill them.

You know how people used to bang on the old tellies when they stopped working? That's basically what psychiatry is. Take a supremely sophisticated mechanism with thousands of intricate moving parts, see that it's not doing exactly what you want it to do, bash the fuck out of it until the snow stops and say it's fixed.

Just remember this: fewer than 40% of patients diagnosed with serious psychiatric illness ever experience some kind of remission. And those that do, relapse.

Just what kind of branch of medicine is this, that consistently fails to cure people? Could it be that we're barking up the wrong tree entirely?

Sorry, typo: fewer than 30%, fat fingers.

Someone said up thread that Psychiatrists have a lot of training, and they do. Psychologists also do. To become a clinical psychologist you need at least a 2.1 degree (preferably a first), usually an MSc (preferably at distinction), usually some publications, a number of years post graduate experience in mental health, often an Assistant Psychologist role (extremely competitive - sometimes 1 place for every 100 applicants), and then after obtaining all that, you then need to complete a 3 year doctorate programme (again - v. Competitive, and places on these doctorate programmes are very few and far between).

Someone up thread asked me how I know that many psychiatrists are horrible about people with PD behind their back, but nice to their face - I know this because I have worked in mental health for nearly 30 years. I have worked with countless psychiatrists. Not one - yes, not one, has refrained from saying horrible things about people with a diagnosis of EUPD/BPD. I have worked with some awful psychiatrists and some good ones. But I am saddened by how prejudice MH professionals,and especially psychiatrists, can be about people with a diagnosis of EUPD/BPD :(

floppy Ive known since I was diagnosed that professionals were shit talking me behind my back because of that diagnosis and its so disheartening. I'm a "quiet" bpd (so it's all internalised but once or twice a year it gets too much and I want to die).

I don't know if it's because it's a hard condition to treat or because it can present challenging frustrating behaviour for professionals but it's the only thing I wish was different in the system and with psychiatrists.

Sorry for derailing. It's a huge issue in the system though and it's where I think some psychiatrists let themselves and their patients down.

I'm really sorry to hear that Alexandra80. I really wish it was different too

Ime psychiatrists shit talk about all kinds of patients. I saw it as a patient myself during care plan meetings and later as an advocate. I no longer do that work but it certainly went on even when I was there in a professional capacity. I always put in complaints, fwiw, but I met some nasty bastards over the years.

Example during my care plan meeting (admittedly I was what was termed "florid" at the time): I do love it when they're manic. It's so much fun.

Utter utter shitwipe of a man.

Berwick how shite of them

I worked at a secure unit for a bit as a healthcare assistant before I got bad and obviously no one besides my boss knew my medical stuff so I got to hear a lot of dehumanising comments made by other staff, often registered mental health nurses but psychiatrists too. Was a real eye opener!

It's awful, isn't it? I heard similar while speaking for others. The guy who said that about me obviously thought that I was so far gone it wouldn't register, even though I remember it twenty five years later, so shows what he knows about human cognition, the cunt, but he's in charge of making decisions about people's liberty. It's shocking, really.

I have worked with several. Most were caring and knowledgeable and overall seemed to be liked and trusted by patients (although there was frustration at the long waiting times sometimes to see them)
One was not.
There’s a shortage of psychiatrists apparently at the moment.
I find it quite scary that although you get good and bad workers everywhere, psychiatrists hold a lot of power and often see people on their own and treat patients who are in a state where they are less able to make a formal complaint, and if they do, it could be minimised as a result of their mental state.
I think this should be a job role more than any where some close scrutiny is regularly given to info about patient and colleague feedback/experience/complaints history, and some more checks and balances put in.
I think the views of carers and admin/reception staff would be valuable here...if they felt able to feed back on behaviour that seems unprofessional or strange it could be worth looking into.
Depends on there being an available pool of good applicants for the job role though I suppose.

Part of the problem is we (general public and medical staff) copy the US where Big Pharma rules and their is a pill for every ill.
We have had, in the past, a huge respect for doctors and trusted them to make the decisions.

Change takes time.
It's reasonable to say that steady combined healthcare with patient input is required - I would think many would agree- but you need educated and accepting patients. Telling someone to go away and come back in 2 weeks to see if you really need the medication. isn't going to cut it. My DH still goes to the doc with a cold, hoping for magic anti-bs.
My family member with dementia has their pills adjusted regularly. And they are quite well. Hallucinations gone.
And it takes a long time to put eg anxiety behind you- and not everyone recovers. Would people live with it in the hope it goes away or demand pills in case it isn't going to.
Telling people they are partially to blame for their mental health problems (other than alcohol or similar) just wouldn't be accepted imv.

I went to see a psychologist and ended up having the raging hots for him. I could tell he liked me too. I quit the sessions after the third one as I couldn't cope with the naughty thoughts I was having

at Weffiepops. It’s worse when you have the hots for your optician and they lean in extremely close to your face...

Sorry to hear your experiences Berwicklad. But antipsychotics do actually work to reduce or stop psychotIc symptoms like delusions, they are not just sedating. They don’t always work. And there are often side-effects. But for some people they are lifechanging and they choose to take medication. Same story for antidepressants.

Again the reality is somewhere between the two polarised opinions, but “pill-shaming” is not helpful for a lot of people who struggle with their mental health.