Top 10 Myths About Psychiatry
There is a lot of misinformation about psychiatry.
Let’s look at some common misconceptions that may surprise you.
MYTH: Psychiatrists only see people with severe mental illness.
FACT: Psychiatrists help patients with a broad range of concerns.
Whether you are dealing with the stressors of a major life change or relationship difficulty to symptoms and conditions like anxiety, depression, or thought disorders: psychiatrists are equipped to help.
The myth that psychiatrists only treat people with severe mental illness came about because psychiatrists are trained to help even with severe and complex conditions. But that is not all psychiatrists do. Many outpatient psychiatrists see a range of conditions and concerns, many of which are common issues many people face. You don’t need to have a severe illness to see a psychiatrist!
MYTH: Psychiatrists just prescribe medication.
FACT: Psychiatrists are trained in psychotherapy (talk therapy) across the four years of residency training required after medical school.
After didactic courses and lectures covering psychotherapy technique, psychiatrists are required to have at least one year where an experienced psychiatrist, doctorate-level psychologist, or other doctorate-level therapist observes the psychiatrist-in-training perform psychotherapy. Many programs require more. To complete residency and become a psychiatrist, the psychiatry resident must demonstrate competency in certain forms of psychotherapy. Some psychiatrists focus solely on therapy in their practice.
The myth that psychiatrists only prescribe medication likely arose because:
Psychiatrists are the specialists with the most training in the clinical use of psychiatric medication. They have experience in treating the full range of concerns, from mild symptoms to patients with complex conditions, including patients with complex medical conditions that also need psychiatric medication. There is a current shortage of psychiatrists. Because so few psychiatrists are available to offer this highly skilled service, many clinics want psychiatrists to focus only on medication management.
To stay open, clinics that take insurance have to consider how insurance reimburses certain services. Therapy takes time, and the way insurance commonly reimburses incentivizes short medication visits over a longer therapy visit. A mental health clinic can provide more medication visits in an hour compared to the number of therapy visits in the same time.
There aren’t a lot of psychiatrists, making few familiar with the training and skills psychiatrists can offer. Even other professionals in the behavioral health or mental health field, because their training path is different from that of a medical doctor, may be unfamiliar with the psychotherapy training requirements for psychiatrists. If their experience with psychiatrists is referring patients for medication, even experienced behavioral health professionals may believe all psychiatrists do is prescribe psychiatric medication.
MYTH: Psychiatrists will force you to take medication.
FACT: Patients may see psychiatrists only for therapy or to see what options they might have to address a particular concern.
Psychiatrists understand the full range of treatment options, from counseling and therapy to medication and other evidence-based interventions, so that they can recommend the best treatment options for you and your individual concerns and wellness goals. They may recommend therapy, medication, other interventions such as treatment of an underlying medical condition, or a combination of these. If treatment options include medication, a discussion of the risks and benefits of medication helps you choose the right fit for you. The psychiatrist should not force you to take medications.
There are very rare situations where a judge may court order treatment of certain psychiatric or substance use conditions. Court-ordered treatment can, in certain cases, specify medication treatment. However, court-ordered medication treatment is a complex process and is not the unilateral decision of a doctor.
MYTH: Psychiatrists believe that mental health conditions are all caused by chemical imbalances
FACT: Psychiatrists train under what is called the bio-psycho-social model.
As human beings, we and our bodies do not exist in a vacuum. We are part of communities and cultures. We are affected by life experiences and the ways we learn to respond to stress or challenges. We inherit genes from our parents, and the activity of these genes can change under stress. Access to needs, such as nutritious food, safe shelter, and social connections, is essential to our overall health—including how we feel, think, and respond to the world around us.
MYTH: Psychiatric medications change your personality.
FACT: There is no such thing as a medication that can change personality. Talk therapy is the mainstay of treatment for patients seeking help for personality disorders.
Medications can make you feel differently, and that can change behavior. For example, a patient who is depressed may feel they have more energy to do things when taking an antidepressant and begin a new hobby or reach out to friends they haven’t spoken to in a while. But this doesn’t mean it changed who they are. Occasionally, patients who take antidepressant medication describe feeling emotionally blunted, but emotional blunting (or the inability to enjoy things previously enjoyed) is also part of depression as an illness. It isn’t clear that the medication is causing this effect, but instead may be a sign the depression symptoms are not yet in remission.
MYTH: Psychiatrists label normal human emotions and experiences as disorders.
FACT: There are specific, often very narrow criteria that must be met for something to be considered a disorder.
Psychiatrists help with concerns that create distress, interfere with a patient’s sense of well-being, or affects ability to carry out day-to-day tasks. While psychotherapy modalities differ, many forms include validation of our experiences as human beings navigating difficulties in life. For example, in ACT therapy, the focus is on addressing underlying experiential avoidance. Experiential avoidance is something we all do time to time when avoiding an emotion, thought, or experience that prevents us from working toward our goals and the life they want to live. Making room for the experience of our emotions, without trying to suppress or avoid them, can be very healing and gives patients new options to choose the direction they want to go in life.
MYTH: Psychiatrists analyze everybody all the time.
FACT: Much of what psychiatrists do isn’t just about assessing a patient’s thoughts and behavior.
Important aspects of care include providing education about symptoms or conditions, considering and discussing options for treatment, and, most importantly: being present with the patient.
Psychiatrists are people. And, like most people, they do not like to work in their off time.
MYTH: Psychiatrists aren’t actually medical doctors.
FACT: Psychiatrists attend the same medical school and receive the same medical doctorate (MD or DO) as surgeons, family practice doctors, cardiologists, and other medical doctors.
Psychiatrists rotate in the same medical specialties as part of their education and learn how to diagnose diseases, perform common procedures, and deliver babies. Only after medical school do doctors specialize in a particular area, such as psychiatry or cardiology, by attending residency and fellowships specific to their specialty.
MYTH: Psychiatry is not based on science.
FACT: Like all medical doctors, psychiatrists use evidence-based medicine.
Evidence-based medicine is where scientific studies examine the effects and benefits of treatment. These studies are reviewed by other scientists and physicians before (and after) publication. This information is then used to update and improve medical care continuously. Therapy is also studied in this way, and many evidence-based therapy treatments are available. For example, cognitive behavioral therapy (CBT) is one of the most studied therapies in the world and has been found to be an effective treatment for many conditions, including depression and anxiety.
MYTH: There is no difference in getting psychiatric medicines from my regular doctor or APRN.
FACT: Psychiatrists have the most training in how psychiatric medications work, when they may or may not be beneficial, what effects to expect, drug interactions, general effects on the body and other medical conditions, side effects, and nuance of what particular medications may work better for an individual patient.
Not even genetic testing or pharmacogenetic testing can offer this level of individualization because drug response and effect aren’t necessarily reflected in this testing. You are more than your genes!
After completing college and four years of in-person education in medical school, a psychiatrist must complete a four-year residency dedicated solely to evaluating and treating psychiatric conditions. To receive board certification, new psychiatrists must pass an extensive examination that goes in-depth into the use of psychiatric medication and other treatments.
Primary care physicians do a three-year residency that covers a vast range of topics. Primary care doctors, PAs, and APRNs must know a broad range of topics, and psychiatry medication is only a small part. Because they have to cover many different topics in their training, education on psychiatric diagnosis and psychiatric medication use must be very general.
Psychiatric Mental Health Nurse Practitioners (PMH-NPs) are APRNs focused on treating mental health concerns using medications. However, APRN training is different from a physician. PMH-NP typically have a bachelor’s degree and nursing licensure (RN). Then, to become PMH-NP, they do two years of training in behavioral health.
Not everyone may need the expertise of a psychiatrist for their antidepressant or other psychiatric medication. However, knowing that options exist can help you decide what is right for you.
References
American Psychiatric Association (2023) Patients and Families: What is psychiatry? https://www.psychiatry.org/patients-families/what-is-psychiatry Accessed 6.25.23.
American Council for Graduate Medical Education (2022) Psychiatry Program Requirements https://www.acgme.org/specialties/psychiatry/program-requirements-and-faqs-and-applications/ Accessed 6.25.23.
