psychiatry isn't 'real medicine', but neither is orthopaedics, radiology, pathology etc. Psychiatry can be frustrating because many patients never get better because they have completed f**ked up social lives, because of the lack of respectability, because everyone has an opinion and thinks they can chime in and know what they're talking about, because the therapies (talking and drugs aren't all that effective), because it is a target for all sorts of fringe groups (e.g. scientologists) who expose the fradulent research (even though there is probably as much fradulent research in other areas), because of the weak evidence base for practice, because unlike clinical psychology, psychiatry doesn't have an over-arching theoretical basis, because some of the patients are simply odious, and because many people who go into psychiatry are lazy, could not get into the specialty of their choice, and have no interest or aptitude in working for the mentally ill.
But it is also good fun, the hours are great, you meet all sorts of wonderful people include some very intelligent and creative individuals, as well as some of the most disadvantaged and inspiring; you get to make cool diagnoses (in the past year i've diagnosed Waldenstrom's macroglobulinemia, paraneoplastic limbic encephalitis, neurosarcoidosis all manifesting as 'psychiatric'), i treated a patient with a phobic disorder with exposure therapy and cured his phobia, I uncovered a history of PTSD and borderline personality disorder in an epileptic patient who had managed to get all sorts of unnecessary surgery for her refractory epilepsy and come up with a plan to stop needless admissions, i cured a young boy who was 'paralyzed' (conversion disorder) with hypnosis and he walked out of the hospital!, treated a schizophrenic patient with psychogenic polydipsia with a sodium of 105, curtailed the florid psychotic mania of a patient with severe bipolar disorder, treated and 'cured' a paranoid psychosis secondary to benzodiazepine withdrawal, provided psychosocial support to a young women dying of breast cancer, have enjoyed the multi-faceted presentations of delirium from the hypoactive to the hyperactive, the sublime to the ridiculous, the saddening to the hilarious...heard a patient with Alzheimer's disease speak for the first (and last) time in 6 months....oh and I get to introduce skeptical medical students to this fascinating specialty, use film and literature to teach my students, and discuss philosophical issues like the concept of mental disorder, the rationality of suicide, the propriety of coercion, and whether the mind even exists.
That might sound like hell to you, but it sound great to me!
