One pill makes you taller and one pill makes you small

There are a slew of cliches anyone becoming a psychologist is subject to...

Are you psychoanalyzing me right now?

So do you diagnose all your friends?

What can you tell about me from the drink I just chose?

What do you think about Dr. Phil?

... and so forth.

One in particular seems to be embedded in our culture.

So, you're a shrink, hey?

Or, alternatively, So, you're becoming a psychiatrist, hey?

Let's be honest, now. How many of you are aware of the differences between a psychologist and a psychiatrist (both linked together under that infamous shrink term)?

In a nutshell, psychiatrists go to med school and have an MD. Psychologists go to graduate school and have a PhD. Psychiatrists can prescribe drugs. Psychologists can't. Psychologists (clinical psychologists, specifically) generally have more training in psychotherapy than do psychiatrists, and also have a much greater specialization in assessment.

But there also seems to be to be a deeper undercurrent than that...

I have no intention of bashing the entire field of psychiatry, a la Scientology. Some of the clinicians I admire most (e.g., Yalom) are psychiatrists, and I've worked with some amazing ones in clinical settings. I also don't want to trash the entire notion of psychopharmacological treatment of mental illnesses. I know a lot of people have benefitted a lot from medication for their depression and anxiety.

However...

There's are aspects of the discipline that bothers me. I think that a lot of this comes out of the deterministic perspective that *some* psychiatrists endorse.... the whole chemical imbalance story. While brain chemistry does clearly play a role in depression and anxiety, it is not so nearly as simple a story as client's are frequently told. EVERYTHING is affected by brain chemistry. A glass of wine technically causes a chemical imbalance, as do eating and sleeping habits. Therapy has been found to cause changes in brain chemistry similar to antidepressants. But people are made to believe that this chemical imbalance is somehow qualitatively different, and, more unfortunately, unchangeable-- as though they will be required to take medication for the rest of their lives as the only way to alter it. 

Again, I don't want to give off the impression that I think these medications are completely useless. They very often give people the boost they very much need, which hopefully gives them the resources needed to make other life changes. But after, in depression groups, you hear people argue against the most basic life changes, such as healthier eating, sleeping, and exercises, let alone in social interactions and ways of thinking, because their depression is "chemical" and thus isn't influenced by external forces, you become frustrated.

This fatalistic view on the part of *some* psychiatrists also results in unfortunate conflicts of interest between our two disciplines. Even in my limited professional experience, I've had client's psychiatrists tell them things that completely contradict our therapeutic goals (and are even utterly factually untrue). Other psychologists have told me tales of psychiatrists telling clients that they have no hope of ever working again or of shaking their symptoms, while, on the other end, their psychologists are trying increase their sense of self-efficacy and belief in recovery.

In all truth, actually, this probably has less to do with the discipline of psychiatry, and more to do with the pharmaceutical industry. A lot of psychiatrists do amazing therapy and well thought out prescriptions. Others, however, have figured out that 15 minute appointments to check in on client's medication, along with the nice financial incentives provided by pharmaceutical companies wooing them, is a lot more financially profitable (and reimbursable by HMOs) than an hour of therapy with medication consultation. 

A lot of these sentiments are coming from the fact that I just finished reading Mad in America, about the history of psychiatric treatment of schizophrenics in North America. It was eye-opening, at the very least, although horrendous would probably be a more appropriate term. I can't begin to explain the horrors medical professionals have committed against the mentally ill-- ripping out teeth, blistering their skin, refrigeration, near drowning, lobotomies with ice picks, induction of seizures, to name a few. And I'm not saying that psychology's name is clear in all of this. I certainly feel my fair share of collective guilt over these atrocities. 

However, the author makes a strong point about the current medical norms regarding psychiatric treatment of schizophrenia. The simple fact that a World Health Organization study showed that schizophrenics in the third world have better outcomes than those in North America should be telling enough. However, he paints a picture of fraudulent motivations and unethical research and marketing practices, all in the name of financial gain-- still taking place today. He tells tales of psychiatric researchers ignoring ethical standards in order to get the best results, and thus the best payouts from the pharmaceutical companies... schizophrenics being yanked off their medication immediately, which is know to result in huge symptom increases, aggression, and frequently suicide, all to provide a placebo group that the medications look admirable against. Of shady tactics to get participants in studies without informing them of the huge risks. Of massive cover-ups of the side effects of antipsychotic medications (which include painful muscle spasms and Parkison's symptoms, as well as a recent link to toxic blood diseases). All in the name of money.

It's hard to accept this in a field you want desperately to believe is about helping. 

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And please don't take this to believe that psychology is the noblest of fields. We are certainly guilty of our fare share of transgressions, from our involvement in some of these horrific early treatments, to cruel research, to even the extreme mistreatment of clients. However, at the very least, by virtue of our training, we have our hand out of the pharmaceutical cookie jar. Although there is a whole 'nother story about how some are trying to gain access to that cookie jar, but that is for another time.