Is psych right for me?

[Braindrayn]

Hello everyone it appears that as 3rd year is winding down for many of us we are all trying to figure out what to do with our lives and I'm no different in that regard which is why I am making this post! So right now I'm trying to decide between either applying to IM and now more recently psych. The reason I'm thinking psych now over IM is I took a good long look at what I was passionate about and I realized I wanted to know more about the mind-brain interface. While I did enjoy IM I did not LOVE it to the extent I thought I would.

I'm an MD/PhD student who finished his PhD in Biochemistry in a field totally unrelated to Psych but what I did learn about was a lot about protein structure/function and drug design concepts which I could easily see being applied to psychopharmacology. As a field that is relatively not as well represented in terms of research I really could see myself making at least some what of a working stab at trying to understand what this black box is that we call the brain/mind. For me the research in understanding mental illness at least from a materialist perspective looks bright for the near future. This is not to mention that in other fields of medicine a lot of the "low hanging fruit" has been taken so to speak.

For me the combination of interesting patients (I absolutely enjoyed working with schizophrenic patients and want to understand how this is reflected at a material level), decent lifestyle/pay/job prospects and interesting research (as I see both neurology and psych blowing up in the coming decades) are very intriguing to me and I'd like to be on the ground floor of that revolution. I guess my biggest hiccup would be losing that "medicine" part of medicine which from what I gather from other threads is not really true as you still use it all the time.

I know this has turned out to be more of a rant than a question but for the TLDR crowd:

1. I want to understand the mind/brain interface at a material level... Does a career in Psych seem like a good fit for me and my goals?

2. Where do you see psych going in terms of treatment modalities in the coming decades and is my vision of what Psych will be in the future generally in line with the thoughts in the field now?

Thanks!

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[nitemagi]

Psych needs quality researchers. Badly.

Join.

 

[punkedoutriffs]

Psych needs quality researchers. Badly.

Join.

Why does it lack them (compared to other fields)?

 

[nitemagi]

It's not that it lacks any researchers, but many are PhDs with little clinical experience, and so IMO can go down roads where they're not always asking the right questions.

There's a big push to get more researchers with clinical training.

 

[punkedoutriffs]

It's not that it lacks any researchers, but many are PhDs with little clinical experience, and so IMO can go down roads where they're not always asking the right questions.

There's a big push to get more researchers with clinical training.

Are universities hard-pressed to recruit physician scientists? Or are there not many positions available?

 

[RustBeltOnc]

Psych is great. If you can handle C/L, etc., you should do it.

 

[MacDonaldTriad]

I describe psychiatry academics as the porridge field of medicine. There is a balance between being the biggest fish, and not being in too small a pond. I think psychiatry is just right. It is large enough, but not as large as all of internal medicine, yet small enough to have your PhD put you above a lot of players. You have to like it, but it has more opportunities than most fields in my biased opinion.

 

[HarryMTieboutMD]

Hello everyone it appears that as 3rd year is winding down for many of us we are all trying to figure out what to do with our lives and I'm no different in that regard which is why I am making this post! So right now I'm trying to decide between either applying to IM and now more recently psych. The reason I'm thinking psych now over IM is I took a good long look at what I was passionate about and I realized I wanted to know more about the mind-brain interface. While I did enjoy IM I did not LOVE it to the extent I thought I would.

I'm an MD/PhD student who finished his PhD in Biochemistry in a field totally unrelated to Psych but what I did learn about was a lot about protein structure/function and drug design concepts which I could easily see being applied to psychopharmacology. As a field that is relatively not as well represented in terms of research I really could see myself making at least some what of a working stab at trying to understand what this black box is that we call the brain/mind. For me the research in understanding mental illness at least from a materialist perspective looks bright for the near future. This is not to mention that in other fields of medicine a lot of the "low hanging fruit" has been taken so to speak.

For me the combination of interesting patients (I absolutely enjoyed working with schizophrenic patients and want to understand how this is reflected at a material level), decent lifestyle/pay/job prospects and interesting research (as I see both neurology and psych blowing up in the coming decades) are very intriguing to me and I'd like to be on the ground floor of that revolution. I guess my biggest hiccup would be losing that "medicine" part of medicine which from what I gather from other threads is not really true as you still use it all the time.

I know this has turned out to be more of a rant than a question but for the TLDR crowd:

1. I want to understand the mind/brain interface at a material level... Does a career in Psych seem like a good fit for me and my goals?

2. Where do you see psych going in terms of treatment modalities in the coming decades and is my vision of what Psych will be in the future generally in line with the thoughts in the field now?

Thanks!

YES YES YES. Psychiatry is ABSOLUTELY the field for you. You are the type of person for whom we would beg. You should read some of Danny Weinberger's (the absolute best and most well known molecular biological psychiatrist today) work. Just type "Weinberger DR" into pubmed or go to libd.org. The basic science in psychiatry is unfolding, and hopefully Cartesian dualism becomes an interesting historical concept but nothing more. Hopefully, people like you will be the ones who drive away unscientific nonsense like psychoanalysis from residency curricula... YES, Psychiatry is for you!

 

[Braindrayn]

Thanks everyone for your replies! It seems like Psych may be able to sate my curiosity (as well as leave me with enough time to do other things after work ). Couple of questions though:

a) Are there any reasons I should NOT do psych? I realize the selection bias is very high on this forum but I'd be curious to know any of the downsides theoretical or practical.

b) Any thought from those more well versed in the literature how treatment will change in the coming decades?

Thanks!

 

[nitemagi]

A. If you don't like seeing patients.
B. Everyone will be guessing. People have been posting on SDN that psychiatry will be merged with neurology for like a decade and there is still zero evidence to support that, even if editorials presenting the idea get published now and then.

 

[smalltownpsych]

Hello everyone it appears that as 3rd year is winding down for many of us we are all trying to figure out what to do with our lives and I'm no different in that regard which is why I am making this post! So right now I'm trying to decide between either applying to IM and now more recently psych. The reason I'm thinking psych now over IM is I took a good long look at what I was passionate about and I realized I wanted to know more about the mind-brain interface. While I did enjoy IM I did not LOVE it to the extent I thought I would.

I'm an MD/PhD student who finished his PhD in Biochemistry in a field totally unrelated to Psych but what I did learn about was a lot about protein structure/function and drug design concepts which I could easily see being applied to psychopharmacology. As a field that is relatively not as well represented in terms of research I really could see myself making at least some what of a working stab at trying to understand what this black box is that we call the brain/mind. For me the research in understanding mental illness at least from a materialist perspective looks bright for the near future. This is not to mention that in other fields of medicine a lot of the "low hanging fruit" has been taken so to speak.

For me the combination of interesting patients (I absolutely enjoyed working with schizophrenic patients and want to understand how this is reflected at a material level), decent lifestyle/pay/job prospects and interesting research (as I see both neurology and psych blowing up in the coming decades) are very intriguing to me and I'd like to be on the ground floor of that revolution. I guess my biggest hiccup would be losing that "medicine" part of medicine which from what I gather from other threads is not really true as you still use it all the time.

I know this has turned out to be more of a rant than a question but for the TLDR crowd:

1. I want to understand the mind/brain interface at a material level... Does a career in Psych seem like a good fit for me and my goals?

2. Where do you see psych going in terms of treatment modalities in the coming decades and is my vision of what Psych will be in the future generally in line with the thoughts in the field now?

Thanks!

Yes. It sounds like it will fit. I chose the field for some of the same reasons. The rest of the body is pretty straightforward in its function. The mind-body-environmet connection and interaction and the biochemical intracellular communication system and the incredible analog/digital brain could probably keep you busy and interested for a few centuries worth of work.

Treatment is going to be with more targeted and thus more effective drugs. Right now we flood the entire system with chemicals which leads to a lot of undesirable effects. Medications will be used more for improving short term function and we will realize more and more how to effect the long term changes and improve our understanding of how medications can either help or hinder that process. Psychiatrists are going to swing back from a medication management only role if they want to continue to have a leadership role and I'm pretty confident they will. Not too many dummies get through med school!

 

[Braindrayn]

I actually quite enjoy talking to patients so I don't see that as a downside. Thanks for the all the replies.... keep em coming if you got any more insights to share! Its sounding more more like I should go into Psychiatry!

 

[OldPsychDoc]

.....
I'm an MD/PhD student who finished his PhD in Biochemistry in a field totally unrelated to Psych but what I did learn about was a lot about protein structure/function and drug design concepts which I could easily see being applied to psychopharmacology. As a field that is relatively not as well represented in terms of research I really could see myself making at least some what of a working stab at trying to understand what this black box is that we call the brain/mind. For me the research in understanding mental illness at least from a materialist perspective looks bright for the near future. This is not to mention that in other fields of medicine a lot of the "low hanging fruit" has been taken so to speak.

For me the combination of interesting patients (I absolutely enjoyed working with schizophrenic patients and want to understand how this is reflected at a material level), decent lifestyle/pay/job prospects and interesting research (as I see both neurology and psych blowing up in the coming decades) are very intriguing to me and I'd like to be on the ground floor of that revolution. I guess my biggest hiccup would be losing that "medicine" part of medicine which from what I gather from other threads is not really true as you still use it all the time.

I know this has turned out to be more of a rant than a question but for the TLDR crowd:

1. I want to understand the mind/brain interface at a material level... Does a career in Psych seem like a good fit for me and my goals?

2. Where do you see psych going in terms of treatment modalities in the coming decades and is my vision of what Psych will be in the future generally in line with the thoughts in the field now?

Thanks!

Your passion and vision will serve you well, but keep in mind that the "mind/brain interface at a material level" is still kind of a mythical holy grail for us. I personally am very skeptical that a bottom-up molecular biologic approach is going to get us there. If you're serious about doing research in this area, then you may need to deepen your understanding of systems neuroscience, and really try to understand brains almost as if they're all individual unique little ecosystems unto themselves. We're further along than when I was doing a neuroscience PhD 20 years ago, or postdoctoral stuff in schizophrenia 12 years ago--but I left for full time clinical work because I just didn't see the personal satisfaction of research approaching anywhere near the satisfaction I got from actually helping a schizophrenic deal with his life. It will very much come down to your own goals and values.

Don't worry about losing medicine. Everyone loses the medicine they don't use. Try asking a neurologist about oral contraceptives sometime. Or get an orthopod's opinion on the optimal management of Type 2 diabetes.

Thanks everyone for your replies! It seems like Psych may be able to sate my curiosity (as well as leave me with enough time to do other things after work ). Couple of questions though:
a) Are there any reasons I should NOT do psych? I realize the selection bias is very high on this forum but I'd be curious to know any of the downsides theoretical or practical.
b) Any thought from those more well versed in the literature how treatment will change in the coming decades?

a) Given what I said above, how are you at dealing with ambiguity and uncertainty? People with mental illness just don't behave like proteins in test tubes or nucleic acids on a gel.
b) Come along and find out with us.

 

[Braindrayn]

I think I'd like to start with a bottom up approach (mostly because I know how stuff works better at that level) but I by no means want to limit myself to it. I think part of what I liked in my brief time during my psychiatry rotation was the ambiguity and uncertainty. I kept asking myself what made these people think or see or hear things this way and was there any way we could objectively come up with criteria to either diagnose or treat these patients. I guess secondarily is it even possible to come up with objective criteria? I think its these types of questions which I find extremely intriguing and are possibly drawing me to this field.

 

[clausewitz2]

Yeah, I would like to echo OldPsychDoc in saying that if you are absolutely burning to have a general theory of the mind-brain interface, make sure there is some other aspect that is rewarding, because you will probably be waiting a long time. There is already a field dedicated to solving this question, namely cognitive neuroscience. It goes back in its modern form until at least Minsky and Papert's critcisms of the Perceptron in the early 60's and has been very active since. Spoilers: the basic questions have not been solved yet. We do not have the tools we would require at present to assess the activity in vivo of cortical columns, almost certainly a basic processing unit in the brain. Be advised that most of the functional neuroscience you will have learned for neurology is either hilariously underspecified or just plain wrong (Broca's area does not equal productive language in the slightest). Probably more philosophy needs to be done prior to anyone having a real shot at reasoning meaningfully from neural entities to cognitive entities in a mechanistic way.

Not to discourage you or anything, just be aware this field is still arguing over definitions in a way that may be very strange to you coming from a bench science.

 

[Jorje286]

Probably more philosophy needs to be done prior to anyone having a real shot at reasoning meaningfully from neural entities to cognitive entities in a mechanistic way.

I doubt philosophy will get us anywhere. I think theory (which will necessarily require advanced mathematical formulations) is our best bet, but it has to have predictions we can test at the experimental level. I also echo OPD that molecular biology is unlikely to answer the questions. I think it will be about figuring emergent properties of complex systems. But I also think a lot of patience and humility are in order. It's very unlikely that we will be able to answer 'the big questions' when there are so many missing links at much simpler levels of behavior/analysis. It says something when Kandel went from psychoanalysis (something he's still very much interested about) to nematodes to figure out something about the brain.

 

[clausewitz2]

I think when there is basic conceptual confusion over the precise identity of the primitives that would be useful to investigate, careful analytic philosophy is probably exactly what we need. In low-level perception, where the outward facing nature of the structures involved allow us to reason more straightforwardly from form to function, this has been less crucial. But even there, it was not really until David Marr in '81 that even vision was thought about in a sensible way.

I should make clear I am not talking about philosophy divorced from science, but rather as something to be done to help define the useful directions of empirical investigation. Useful philosophy, I think, may be what you mean by "theory".

 

[Jorje286]

I think when there is basic conceptual confusion over the precise identity of the primitives that would be useful to investigate, careful analytic philosophy is probably exactly what we need. In low-level perception, where the outward facing nature of the structures involved allow us to reason more straightforwardly from form to function, this has been less crucial. But even there, it was not really until David Marr in '81 that even vision was thought about in a sensible way.

I should make clear I am not talking about philosophy divorced from science, but rather as something to be done to help define the useful directions of empirical investigation. Useful philosophy, I think, may be what you mean by "theory".

I agree about the problems with concepts and definitions, but imo those troubles arise because we don't have a more scientific formulation of even simpler processes (say perception, which is obviously a very complicated topic in its own right) so we are left with our daily-folk, common-sense definitions which may not map all too well to reality. Much of cognitive science sometimes take things like 'thought' and 'consciousness' for granted and builds on them.. but if we don't have a clue what these are, how can we proceed? IMO the solution is not more philosophy, but a patient and slow-moving bottom-up approach with a lot of theory on how the pieces can fit together.

 

[clausewitz2]

Jorje, I think we are largely in agreement as to the description of the problem, even if we differ in how we think it ought to be solved. I will confess I am coming from a perspective of the observation Chomsky loves so much, that for any given data set, there are in principle an infinite number of models that can explain it. This to me says part of the solution will involve careful work to winnow down that possible solution-space if we are going to make much headway in reliably testing our theories.

Regardless, it is all rather a mass of gray fog when compared with, say, biochemistry.

 

[Nasrudin]

Jorge, I like the idea of exploring emergent properties of complex systems in the same way that I think AI will produce an alien consciousness before we figure out the nuances of our own.

 

[Braindrayn]

Funny how philosophy was eventually brought up in this thread! I actually quite enjoy philosophy too and theories of mind are something I find very interesting which is also probably another reason Psych seems appealing to me! Although I do feel that our minds must be explainable at some level in the physical realm, maybe not at exactly totally at the molecular level but I figure we gotta start somewhere right?

 

[clausewitz2]

Jorge, I like the idea of exploring emergent properties of complex systems in the same way that I think AI will produce an alien consciousness before we figure out the nuances of our own.

The great danger in starting to talk about emergent properties without a high degree of specification is that it can very quickly become an excellent hand-wave to cover over significant gaps in knowledge or flawed understandings.

 

[HarryMTieboutMD]

From one of the greatest, most important psychiatrists of all time:
"It is argued that because it is difficult to measure psychologic phenomena and to characterize psychiatric disturbances...too much should not be expected.... But to abdicate the role of constructive critic is to abandon the field to the tenderminded. The difficulties of the field seem to require just the opposite: a commitment to toughmindedness.... Paradoxically, such toughmindedness is sometimes attacked in the name of humanitarianism, It is asserted, or implied, that a critic who demands 'data,' who asks about control, who insists that the burden of proof is on the affirmative, reveals thereby that he is not interested in people.... But scientific skepticism is in no way incompatible with compassion for the sick or disabled. In fact, it is the desire to help patients that causes one to be frustrated by the lack of definite knowledge about what really helps and what does not."
-Samuel B. Guze, M.D.

 

[Braindrayn]

So I've got a question about the practical aspects of applying into psych. Since I am sort of deciding so late to possibly apply I may not be able to get a Psych AI under my belt as soon as I would like (most of the early slots are taken). Obviously this will hurt me but is it a deal breaker? Anyone have any suggestions?

 

[Nasrudin]

So I've got a question about the practical aspects of applying into psych. Since I am sort of deciding so late to possibly apply I may not be able to get a Psych AI under my belt as soon as I would like (most of the early slots are taken). Obviously this will hurt me but is it a deal breaker? Anyone have any suggestions?

I would say inconsequential to totally irrelevant to your application.

 

[Petypet]

I would say inconsequential to totally irrelevant to your application.

How about if you don't have any psych LOR yet?

 

[Nasrudin]

How about if you don't have any psych LOR yet?

you need that. i think programs require them.

Also get a second opinion on the AI. WTF do I know. except that applicants fret for no reason. myself included.

 

[Braindrayn]

Hey thanks everyone for your responses! Can I get some further suggestions on what to do if I can't get a psych AI in before applications? I think I can still get two letters (1 from the clerkship director and another from an attending I worked with). I might be able to get an AI in pretty much after applications go out (AI beginning in September). Will this hurt me? Can I still apply and forward my AI letter to the programs I apply to after applications go out?

Thanks!