Why Psychiatry?

 

While many debate the purpose of life, the only one that makes sense to me is to achieve inner fulfillment while making the world a better place; in other words, to be happy and productive.  Most religions say something like this; some secular philosophers agree. Clinical psychiatry and psychology exist to help people meet these basic goals. 

Sigmund Freud and most others have defined normal function as the ability to love and to work, i.e. to sustain intimate relationships and to be productive. Note how similar this measure is in function to the commonly held purposefulness described above. Being fulfilled and happy while functioning is an extra treat, easy for some and difficult for others. Psychiatric problems break down into two broad categories: impaired function and impaired fulfillment. Nevertheless, people become happier doing the right thing even when it doesn’t come easily, so it’s a good idea to try to function while you and I are working on both function and fulfillment.

For a child, relationship capacity depends initially on the parents, and shifts gradually to the child as he or she progresses to adulthood. Productivity in children is most easily observable in schoolwork, but also can be notable in art, sports, and their other interests. For adults, productivity can be measured in a career, an art, parenting or any combination thereof.

Normal Maturation: How a helpless infant becomes a helpful adult

 

As children, we want to feel safe, loved, and valued, in that sequence as we age from infancy through kindergarten. By age 6, we should feel secure in the first two and be working on the third if we’re on track to happiness. In latency, age 6 until puberty, we should develop a sense of mastery of our environment. In early adolescence, we develop our sexual and social identities, and by late adolescence our capacity for intimacy. 

In adulthood we want to be normal, usually defined as an ability to love and to work. This means we should be able to sustain an intimate relationship with another adult person, and be productive as defined above.

Problematic Maturation: Bumps along the way

 

Few people have perfect childhoods. Both the normal development described above, and problematic or abnormal development are molded by 3 forces:

  1. Our inherited temperament, aptitude, and mood volatility: if we’re sad, excitable, or impulsive, it’s harder to accept rules, study, and make good decisions.

  2. Our environment, especially the parenting we experience: if our parents are unreliable, unavailable, or in conflict, we can run a little short on feeling safe, loved or valued.

  3. What our mind makes of the first two, especially the unconscious fantasies, conscious beliefs, and coping styles we develop. Positive examples are: believing oneself able to make things right by exerting effort; avoiding impulsivity by asking advice. Negative examples are: believing the world to be dangerous; feeling anxious about effort, guilt about desire, or ourselves undeserving, 

 

If these bumps are sufficiently obstructive, our minds, having survived so far by depending on a defensive and/or self-effacing theory of life, can no longer adapt to new responsibility. At that point we develop symptoms that impair function in school, careers or relationships. 

In children, many disorders result from abnormal maturation of the brain, including attention deficit disorders, learning disabilities, and tic disorders.  Other childhood symptoms include mood and anxiety disorders. In adults, the most common symptoms are anxiety, depression, bipolar and other mood swing disorders, and substance abuse. 

About 12% of Americans have persistent anxiety disorders, usually beginning in adolescence; incredibly, they wait an average of 13 years before seeking formal treatment. Major Depressive episodes occur in 7% of the adult population every year, and in 13% of the population at some point in life. Despite the availability of successful treatments, individuals with Major Depression wait an average of 7 years before seeking treatment, with consequent career failures and an average productivity loss of 40 days per year.  

Patients prescribed appropriate medication can obtain significant relief from their symptoms in weeks, becoming happier and more productive. This change renders them more emotionally available, and more able to explore any psychological causes of symptoms in psychotherapy. 

Everyone can benefit from psychotherapy with a skilled psychotherapist. Some   need it more than others. People with self- defeating coping styles need it the most. These people repeat self-critical thought patterns and repeatedly make poor relationship choices, often in a characteristic manner.

What distinguishes psychiatrists, psychologists, and other psychotherapists from one another?

All psychiatrists and psychotherapists are trained in some forms of psychotherapy, or the use of words and ideas to modulate change.  

Psychologists have earned a doctorate (PhD or PsyD) in a usually more rigorous psychotherapy training program than those with Masters level degrees (MFT, or LCSW), and had to defend a doctoral level research thesis. Psychologists are also trained to perform psychometric written tests that assess personality and function. However, many Masters level therapists are talented and highly skilled, but wanted to begin clinical practice more quickly. Each psychotherapist, regardless of training, develops a style based on one or two models, e.g. Cognitive- Behavioral, Interpersonal, or Psychoanalytic models.

Psychiatrists are also physicians (MD's), and can therefore better distinguish neurologic from psychological illness, and can provide treatment for ailments that have both a psychological and physical component, such as substance abuse disorders, migraine headaches, and tic disorders. As physicians, psychiatrists can order laboratory tests and prescribe medications.

Dean

Freedlander MD

San Francisco   415.399.0642
            San Jose    408.882.3988
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