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A psychiatrist is a licensed physician, usually a M.D. or D.O., who, after training as a physician, has specialized in the evaluation, diagnosis, and treatment of mental disorders.   Psychiatrists can, and usually do, prescribe medication as part of the treatment they provide.

Who is a Psychiatrist


Psychiatry is the branch of medicine that studies, diagnoses, and treats mental illness and behavioral disorders. While all physicians encounter patients with mental health problems, and any of them try to help their patients by treating the mental health issue, psychiatrists specialize in this area. They are more extensively trained than the general physician in distinguish and treating the various forms of mental illness. Many other professionals also provide mental health care, such as psychologists and social workers.  In the U.S., in general, only medical doctors or physician assistants may prescribe mental health medication.

Psychiatric treatment for any given condition is variable from patient to patient, with some patients having complete resolution of symptoms and others unfortunately having poor or minimal response. The majority of patients will fall somewhere in between.

In general, psychiatric treatments have improved significantly over the past several decades, beginning with the advent of modern psychiatric medications. In the past, psychiatric patients were often hospitalized for six months or more, with a significant number of cases involving hospitalization for many years. Today, most psychiatric patients are managed as outpatients. If hospitalization is required, the average hospital stay is around two to three weeks, with only a small number of cases involving long-term hospitalization.

Practicing psychiatrists may specialize in certain areas of interest such as psychopharmacology, mood disorders, neuropsychiatry, eating disorders, psychiatric rehabilitation, crisis assessment and treatment, early psychosis intervention, community psychiatry and various forms of psychotherapy and psychoanalysis.

Various forms of medication, therapy and counseling are used to deal with mental and behavioral conditions, although many psychiatrists use medication as their primary mode of treatment. Commencing treatment with medication usually requires the patient to agree to this treatment.  Many psychiatric medications can produce side-effects in patients and hence often involve ongoing therapeutic drug monitoring.

Psychiatric patients may be either inpatients or outpatients. Psychiatric outpatients periodically visit their psychiatrist for consultation in his or her office, usually for an appointment lasting 15-45 minutes. These consultations normally involve the psychiatrist interviewing the patient to update their assessment of the patient's condition and the management of any medication. The psychiatrist may also provide psychotherapy. The frequency with which a psychiatrist sees a patient varies widely, from days to months, depending on the type, severity and stability of each patient's condition.

Psychology or Psychiatry

Psychiatry is practiced by psychiatrists, who are become medical doctors first and who then specialize in mental health and illness.  They are trained in the medical approach to disorders and in the use of medications. Many, but not all, psychiatrists are also trained to conduct psychotherapy.

Psychology is the larger study of human behavior. A psychologist is concerned with the study of normal everyday human behavior as much as it is the study of mental health and illness. Psychologists may study how drugs or other chemical agents affect the brain, but generally are not trained to prescribe or administer drugs. Clinical psychology is the branch of psychology that specializes in understanding and helping those experiencing mental distress, physical problems, and/or behavioral problems. Clinical psychologists have extensive postgraduate training in mental health, psychological assessment, psychotherapy, and psychosocial interventions, and are often found working in similar settings and with the same kinds of patients or clients as psychiatrists. Unlike psychiatrists, they start with a general psychological training rather than a general medical training, before continuing with advanced postgraduate courses. They do not always assume a medical model. Clinical psychologists are generally not authorized to prescribe medications in the United States.

In the United States, both psychologists and psychiatrists can be 'Board Certified' as specialists in their field.  After the completion of many years of advanced graduate school, an internship or residency is usually required. After completing their training and after having significant field experience, the psychologist or psychiatrist must pass a written and then oral board examination before becoming 'Board Certified'

Understanding Anti-Psychiatry


The following has been adapted from the wikipedia.org website. 

Anti-psychiatry refers to approaches which fundamentally challenge the theory or practice of mainstream psychiatry in general, and biological psychiatry in particular. Anti-psychiatric criticisms of mainstream psychiatry include that it uses medical concepts and tools inappropriately, that it treats patients against their will or inappropriately dominates other approaches to mental health, that its medical and ethical integrity are compromised by its financial and professional links with pharmaceutical companies, and that it uses a system of categorical diagnosis that is stigmatizing (the Diagnostic and Statistical Manual of Mental Disorders) and is perceived by too many of its patients as demeaning and controlling.

A significant minority of mental health professionals and academics profess anti-psychiatry views, and even some psychiatrists hold such views in regard to mainstream (biological) psychiatry.  Psychiatrists generally view anti-psychiatry as a fringe movement with little or no scientific validity, although it is difficult to quantify the proportion of the general public or professionals involved, or the range of views held.

Despite its name, the movement is often seen as promoting a type of psychiatry itself, albeit one that is in stark contrast to current mainstream thinking. Thus many so-called "anti-psychiatrists", including psychiatrists with non-mainstream beliefs, are keen to dissociate themselves from the term and the pejorative associations it has attracted.

Origins of anti-psychiatry

There was opposition to psychiatry from its origins and as it became more professionally established during the 19th century. Disputes often concerned custodial rights over those seen as “mad”, including in the expanding lunatic asylums, and divergent theoretical interpretations of mental problems.

In the 1920s surrealist opposition to psychiatry was expressed in a number of surrealist publications. In the 1930s several controversial medical practices were introduced including inducing seizures (by electroshock, insulin or other drugs) or cutting parts of the brain apart (leucotomy or lobotomy). Both came into widespread use by psychiatry, but there were grave concerns and much opposition on grounds of basic morality, harmful effects, or misuse. In the 1950s new psychiatric drugs, notably the antipsychotic chlorpromazine, were designed in laboratories and slowly came into preferred use. Although often accepted as an advance in some ways, there was some opposition, due to serious adverse effects such as tardive dyskinesia. Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control. There was also increasing opposition to the use of psychiatric hospitals, and attempts to move people back into the community on a collaborative user-led group approach ("therapeutic communities") not controlled by psychiatry.

Coming to the fore in the 1960s, "anti-psychiatry" (a term first used by David Cooper in 1967) defined a movement that vocally challenged the fundamental claims and practices of mainstream psychiatry. Psychiatrist Thomas Szasz argued that "mental illness" is an inherently incoherent combination of a medical and a psychological concept, but popular because it legitimizes the use of psychiatric force to control and limit deviance from societal norms. Adherents of this view referred to "the myth of mental illness" after Szasz's controversial book of that name.

In addition, Holocaust documenters argued that the medicalization of social problems and systematic euthanasia of people in German mental institutions in the 1930s provided the institutional, procedural, and doctrinal origins of the mass murder of the 1940s. The Nuremberg Trials convicted a number of psychiatrists who held key positions in Nazi regimes. Observation of the abuses of psychiatry in the Soviet Union in the so-called Psikhushka hospitals also led to questioning the validity of the practice of psychiatry in the West. In particular, the diagnosis of many political dissidents with schizophrenia led some to question the general diagnosis and punitive usage of the label schizophrenia. This raised questions as to whether the schizophrenia label and resulting involuntary psychiatric treatment could not have been similarly used in the West to subdue rebellious, though basically sane, young people during family conflicts.

New professional approaches were developed as an alternative, or complement, to psychiatry. Social work, humanistic or existentialist therapies, counseling and self-help developed and often opposed psychiatry.

Additionally, and largely separately, some contemporary cults or new religious movements, most notably Scientology, began challenging aspects of psychiatric theory or practice.

Normality and illness judgments

Critics of psychiatry generally do not dispute the notion that some people have emotional or psychological problems, or that some psychotherapies do not work for a given problem. They do usually disagree with psychiatry on the source of these problems; the appropriateness of characterizing these problems as illness; and on what the proper management options are. For instance, a primary concern of anti-psychiatry is that an individual's degree of adherence to communally, or majority, held values may be used to determine that person's level of mental health.

Psychiatric labeling

There are recognized problems regarding the diagnostic reliability and validity of mainstream psychiatric diagnoses, both in ideal controlled circumstances (Williams et al. 1992) and even more so in routine clinical practice (McGorry et al. 1995). Criteria in the principal diagnostic manuals, the DSM and ICD, are inconsistent (van Os et al. 1999). Some psychiatrists who criticize their own profession say that comorbidity, when an individual meets criteria for two or more disorders, is the rule rather than the exception. There is much overlap and vaguely-defined or changeable boundaries between what psychiatrists claim are distinct illness states. There are also problems with using standard diagnostic criteria in different countries, cultures, genders or ethnic groups. Critics often allege that Westernized, white, male-dominated psychiatric practices and diagnoses disadvantage and misunderstand those from other groups.

Psychiatry and the pharmaceutical industry

Stern concerns about how disease is managed in large populations for financial purposes alone appear constantly in the literature critical of the medical profession and the industry.

Psychiatrists prescribe drugs for adults and children. Administration of the drugs can be undertaken voluntarily or, in certain situations, involuntarily. Psychiatrists claim that a number of medications have a proven efficacy for improving or managing a number of mental health disorders. This includes ranges of different drugs referred to as antidepressants, tranquilizers and neuroleptics (antipsychotics).

On the other hand, organizations with thousands of members such as MindFreedom International and World Network of Users and Survivors of Psychiatry maintain that psychiatrists exaggerate the evidence of medication and minimize the evidence of adverse drug reaction. They and other activists also complain that individuals are not given sufficient balanced information or truly informed consent, that current psychiatric medications do not appear to be specific to particular disorders in the way mainstream psychiatry asserts; and psychiatric drugs not only don't correct measurable chemical imbalances in the brain, but also induce undesirable side effects.

The influence of pharmaceutical companies is another major issue for the antipsychiatry movement. The pharmaceutical industry is one of the most profitable and powerful in existence, and there are many financial and professional links between psychiatry, regulators, and pharmaceutical companies. Drug companies routinely fund much of the research conducted by psychiatrists, advertise medication in psychiatric journals and conferences, fund psychiatric and healthcare organizations and health promotion campaigns, and send representatives to lobby general physicians and politicians.

Peter Breggin, Sharkey, and other investigators of the psycho-pharmaceutical industry maintain that many psychiatrists are members, shareholders or special advisors to pharmaceutical or associated regulatory organizations. There is evidence that research findings and the prescribing of drugs are influenced as a result. A United Kingdom cross-party parliamentary inquiry into the influence of the pharmaceutical industry in 2005 concludes: "The influence of the pharmaceutical industry is such that it dominates clinical practice" and that there are serious regulatory failings resulting in "the unsafe use of drugs; and the increasing medicalization of society".

The number of psychiatric drug prescriptions have been increasing at an extremely high rate since the 1950s and show no sign of abating. In the United States antidepressants and tranquilizers are now the top selling class of prescription drugs, and neuroleptics and other psychiatric drugs also rank near the top, all with expanding sales.

Psychiatry and the Law

Psychiatrists often give testimony in competence hearings. These hearings seek to determine whether an individual is mentally fit to face trial. They also often testify in trials in which the insanity defense is used. Some mental health professionals dispute the right of psychiatrists and the judicial system to do this or the way in which they do it.

While the insanity defense is the subject of controversy as a viable excuse for wrong-doing, other critics contend that being committed in a psychiatric hospital is often much worse than criminal imprisonment, since it involves the risk of compulsory medication with neuroleptics or the use of electroshock treatment.

Additional Information

More information about psychiatry is available on the websites listed below. 

 wikipedia.org website
 World Psychiatric Association
 American Psychiatric Association
 American Academy of Child and Adolescent Psychiatry

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