Can Psychiatry Turn Itself around?

The public is deeply skeptical about the profession—but given the problems of addiction, depression and other forms of mental illness, we need it more than ever

 

Psychiatry needs help.

Mental health has become a national issue, as growing numbers of mentally ill people have filled our streets and our jails. Yet the public remains deeply skeptical of psychiatrists, our doctors best equipped to care for these patients.

In a 2012 Gallup poll, 70 percent of Americans surveyed felt that medical doctors have “high” or “very high” standards of honesty and ethics. By comparison, just 41 percent attributed the same traits to psychiatrists, though psychiatrists are in fact medical doctors. That Gallup even separated psychiatry from the rest of medicine in the survey says a great deal about perceptions of the field.

Despite recent advances in the diagnosis and treatment of mental illness, many still view the work of psychiatrists as a kind of pseudoscience, somewhere between neuroscience and voodoo. A recent British studypresented to the Royal College of Psychiatrists found 54 percent of surveyed patients did not know that psychiatrists have a medical degree. Even more troubling, 47 percent of these respondents said they would feel uncomfortable sitting next to a psychiatrist at a party.

These misconceptions have a crippling effect on mental health care. In the US, psychiatry remains among the least desired specialties to apply into, struggling every year to recruit new doctors. Psychiatry programs attract medical students with lower board scores and fewer academic honors on average compared to other specialties. Friends and family often deride applicants for choosing psychiatry, including me when I joined the field.

So at a time when we need psychiatrists most, we instead face a growingshortage of these critical providers. According to a study published last month in Health Affairs, the ranks of practicing physicians in the US as a whole increased by 14.2 percent between 2003 and 2013, whereas the number of practicing psychiatrists actually declined by 0.2 percent. Many patients with mental health needs face lengthy waiting times and difficulty getting the right care.

So where do we go from here?

Mental health advocates have called for an array of policy changes. Better salaries might draw more providers into the specialty. More funding for mental health research could fuel discoveries like blood tests or novel therapies that propel psychiatric care in new directions. Tying the classification of mental disorders more closely to neuroscience might enhance public trust in the validity of these diagnoses.

These reforms are badly needed. But, to save the field, psychiatrists also need a wake up call. When it comes to reinforcing stigma against the profession, we can be some of the worst offenders.

In hospitals across the nation, psychiatrists often distance themselves from their medical training, refusing to perform physical exams on patients and consulting other specialists for basic medical questions. Don’t we also complete medical school and residency? Psychiatrists must be able to maintain their clinical skills and to recognize the varied medical causes of psychiatric symptoms. We need to work at the interface of mind and body in order to provide the best care for our patients.

Then there’s the matter of medications. Many label psychiatrists as “pill pushers,” and higher insurance reimbursements for drugs over talk therapy have indeed driven increased prescription practices. Yet psychiatrists also bear some of the blame for this reputation. Too often, we turn to the prescription pad when we should be taking the time to sit down and to figure out the root causes of a patient’s symptoms. It’s far easier to change a dose or add another pill than to do the hard work necessary to treat mental illness. These shortcuts are convenient, but detrimental to both the profession’s reputation and patient care.

In the media, psychiatrists who misuse their expertise further harm the credibility of the field. Despite warnings from the American Psychiatric Association, psychiatrists regularly analyze public figures, like President Obama or Donald Trump, without ever meeting these individuals. Others use their credentials to promote pseudoscientific ideas, whether claiming demonic possession is real or analyzing Superman’s emotional issues.

Psychiatry has come a long way from the barbarisms of lobotomy and the fallacies of Freud. Today, it can be among the most inspiring medical specialties. We stabilize the acutely suicidal and care for those gripped by depression, ensure the safety of the psychotic and save patients from the ravages of addiction.

But the field still struggles to be taken seriously, even as our patients need us more than ever. To restore it, psychiatrists must not only step into the policy arena, but we also have to address these self-inflicted wounds. In doing so, we can lessen the pervasive stigma against mental illness and help turn around our ailing profession.

 

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