More than meds

Across much of America, psychiatry increasingly focuses on symptom checklists and 15-minute "med check" appointments.  This trend trades away the richness of human experience — sometimes for good reasons, but often with no good justification.

Naturally, there are circumstances when symptom control is top priority.  Quick relief of agonizing emotional distress or incapacitating thought distortions is a crucial service provided by psychiatrists  in hospitals and other acute settings, as well as in many clinics and private offices.  This type of psychiatry has a surgical flavor.  Those who practice it skillfully derive the satisfactions of a surgeon: they take definitive action and see rapid results.  The work can be quite gratifying for the doctor who wants to make a difference right away.  From the patient's perspective it is also like surgery.  Intolerable emotional states yield to extreme measures: powerful medications, hospitalization, even "shock treatment" (ECT).  Many patients willingly accept the side-effects and other risks of such treatment in order to regain the ability to function at work and home.

However, most people who suffer from emotional or relational issues do not need "surgery."  Over the past couple of decades, qualities long considered personality features — shyness, moodiness, social awkwardness, explosive anger, and many others — have become diagnosable mental disorders.  For example, shyness is now called "social anxiety disorder."  For many doctors as well as patients, these new diagnostic terms seem to call for a quick, symptom based cure (i.e., "surgical" treatment).  Yet even with its updated name, shyness still has a lot to do with self-image, fear of humiliation, and anxious uncertainty about the reactions of others.  Although an SSRI antidepressant may successfully quell the anxiety — during the time it is taken — it doesn't alter these underlying issues.

Mental well-being is subtle and multifaceted.  Outside of treating severe conditions and emergencies, symptom-focused psychiatry may shortchange those who seek help.  Seeing ourselves and others as more than a collection of symptoms, and mental health as more than treating a diagnosis, sets our sights higher.

I am a psychiatric educator as much as a clinician, so I included extra information on this website for those wanting to learn more about psychiatry and mental health.  In the following pages I offer a brief history of psychiatry, discuss which types of treatment are best suited for which types of problems, and further break down different types of psychotherapy and psychotherapists.  At some point I may add additional pages.  My psychiatric blog "Reidbord's Reflections" is here as well, and I am happy to receive your comments and feedback on any of the more than 130 posts.  Dive in.