Okay, quick one: when you read that, what was the first thing that came to your mind? Be honest, now. Did you think, “mad people,” half-clothed, muttering to themselves, or jerking around in uncontrollable rage?
I did that because I’ve found that when I tell people I’m a psychiatrist, one of the first thoughts in most people’s minds is something along the lines of “mad people,” or “madness” – which is unfortunate, because psychiatry is so much more than that. In fact, psychiatry is not about “madness” at all. Interestingly, people often interpret that as an attempt at being politically correct, but it’s not at all. It’s just fact.
What psychiatry really is about is… Mental and behavioural disorders
That’s the proper name, actually, but it’s a mouthful. Imagine having to say that every single time. In fact, don’t imagine; just try it yourself. Try reading up to here again, but reading, “mental and behavioural disorders,” every time I wrote “psychiatry.” It’s no fun, trust me. (Mostly we in the field just say “mental disorders,” or “mental illness.”)
“Mental and behavioural disorders” really gets it, though. And that’s a major reason why thinking of psychiatry as the medical specialty that deals with “mad people” is a misconception. The kind of people we think of as “mad” constitute only a very tiny subset of the vast number of people who can be helped by psychiatry.
Which is another issue with misunderstanding the scope of psychiatry. It means lots of people who would be really helped by a psychiatrist don’t even realise it, and don’t have anyone around them who does. And even if there were, God help that person if should dare suggest psychiatric help!
It’s all just a mess.
But we can try to untangle it by looking at a few other things that come under the psychiatry’s wide scope.
Pregnancy- and menstruation-related disorders
Any woman (or her partner) knows that pregnancy and menstruation often come with emotional changes. But sometimes things go from just emotional to being serious enough to affect the woman’s ability to continue her normal life. Which is where a psychiatrist or other mental health professional might need to come in.
Yes, sexual disorders are a major reason to see a psychiatrist. And the reason is simple when you think about it: once you rule out sexual problems caused by physical conditions, all that’s left is problems of behaviour. Which other doctor can you think of who would handle that?
Almost everyone knows someone who used to bedwet. (Or maybe even still does.) And although there are all kinds of ways people try to address bedwetting, most people I’ve met don’t seem to even consider psychiatric help as an option. But once you rule out physical causes, bedwetting (or enuresis, as we call it) is totally a behavioural problem.
Alcohol and drug use problems
Most people don’t really think of alcohol and drug use problems as psychiatric, except the person starts to behave unusually or something. Which is sad, because harmfully using drugs and alcohol is already a behavioural problem. Waiting until abnormal behaviour starts means many who are already living below their potential don’t get help.
Did you ever see Iron Man 3? Tony Stark (played by Robert Downey Jr) was having attacks of sudden anxiety where he would basically freak out and have flashbacks (from his near-death experience in Avengers — you saw that, at least?). You may not have known specifically, but those were panic attacks and his problem was something along the lines of PTSD (post-traumatic stress disorder). Which is totally a psychiatric problem — he definitely needed to see a psychiatrist or other mental health professional.
I see kids all the time who struggle in school and everyone thinks they’re dumb. Which is sad, because some of them are trying very hard, but they’re struggling with learning difficulties like dyslexia (reading disorder) and dyscalculia (arithmetic disorder). Kids with problems like this don’t do well because skills they struggle with skills most other kids can luckily take for granted. And our whole system of education is based on the assumption they already have these skills. (Imagine what it’s like for those who don’t.)
I’ve seen people with elderly relatives who have been forgetting stuff consistently for years, but they didn’t realise that was a problem. They assumed it was part of normal old age. (It’s not). By the time these people get to the hospital (usually because of unusual behaviour, which is the only mental health symptom most people know), it’s late. Maybe not too late, but later than would have been ideal.
These are just a few, obviously. I havent mentioned eating disorders, or child and adolescent behavioural disorders, or other disorders of old age and so on. I’ve said nothing about conversion disorders and somatisation disorders and other kinds of schizophrenia.
But I intend to. Because you can’t rise above it if you don’t know what “it” is.
What did you always think psychiatry was about? Which of the disorders in this article comes as the biggest surprise to you?