INSIDE THE MIND OF A PSYCHIATRIST

Just recently, a patient who I hadn’t seen for decades, responded to one of my posts with a scathing rebuke of me, psychiatry, and the overuse of medication. He felt he was mistreated with drugs, psychiatry in general, and me in particular – a know-it-all attitude – that caused him enormous pain and suffering.

I remember him well and knew him to be a caring, bright person, who certainly wouldn’t set out to be mean or devaluing without cause.

He challenged me to examine myself and my profession. After getting over the initial shock and sadness that he felt the way he did, I decided to do what he suggested. So here goes…

After my training, as a young psychiatrist (so long ago), I really believed that most problems could be solved with psychotherapy – making the unconscious conscious. In short, understanding repressed memories and feelings could lead to having the freedom to make real choices, not choices based on unconscious rules that were embedded at a very young age. For example: not being allowed to hate a loved one often led to unconscious anger and subsequent depression.

It took a few years in practice for the realization that “talk therapy” could be very helpful for many patients, but not all. Schizophrenia, Bipolar Disorders, severe depressions, overwhelming panic disorders etc. almost always needed the use of medication. Miracles occurred. People who suffered for years, got better when the right medication was prescribed. Sadly, the miracles didn’t always happen. More often, a combination of psychotherapy and medication was helpful, but not perfect.

In fact, the practice of psychiatry is not perfect. Antidepressants work in only 66% of patients. Antipsychotics are helpful but there is no cure for Schizophophrenia. Mood stabilizers are necessary in bipolar disorders but there is always the chance of a reoccurrence of symptoms or side effect from the medication. Anxiety disorders (panic disorders, OCD, general anxiety) could get some relief from anti-anxiety meds, but there is always the danger of addiction, side effects, and break-through anxiety and/or symptoms.

What in life is perfect? Unspoiled Nature? First love? A really good pizza? But, even with these, there’s a long list of hazards.

Then there’s psychotherapy… The therapist uses his/her own feelings, intellect and experiences to help a patient understand what unconscious thoughts and feelings might be lurking within his mind. Since no one (even Donald Trump) is perfect, you can readily imagine that neither are therapists (no matter how well trained and dedicated). THERE IS NO PERFECT! So sometimes therapists fail.

Yet, and back to the original question, are medications (and I’ll add the whole profession of psychiatry to the equation) as terrible as my ex-patient expressed? For him, and I still feel badly, it was not helpful.

For others, I still believe, even after all these years, that it is the best thing that we have. One day, with genetic engineering or who knows what, it will be better.

So what advice do I have, given the state of the art?

Be brutally honest with your psychiatrist.

If a medication doesn’t work, it doesn’t work.

If your therapist interprets something that you disagree with, DISAGREE!

State your mind.

Do everything in your power to honestly clarify your feelings and ideas.

Never give up! If psychiatry doesn’t work, keep plugging away and search for another solution. Even with all our current strife, COVID, and whatever else we need to contend with, life without psychological pain can be wonderful.

If you enjoyed reading, Inside the Mind of a Psychiatrist, you might also enjoy Dr. Smukler’s novels – Chasing Backwards, a psychological murder mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear. All are available as paperbacks and eBooks.