So, why did you select Psychiatry?

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Really just curious to any practicing or PGY psychiatrists out there. Why did you choose Psychiatry? I personally feel as though to be a Psychiatrist required a VERY special type of person (in a good way!) I do not think I would be able to handle the demands of a Psychiatrist those days can be a lot more stressful than what people think.

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I chose the field because I wanted to work with patient populations that others might not want to work with. I also chose it because of the ability to practice while maintaining the option of having a great work life balance. Outpatient usually can have a higher functioning patient population, but many times you are on call 24/7. Inpatient has more acute patients, but when you leave work, you usually don't have to be on call unless you are assigned coverage.
 
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So, why I chose psych. I applied to pediatrics, psychiatry, and triple board. I interviewed at programs of all three types and I ranked all three types of programs. I ended up ranking psych programs at the top (one exception, Brown Triple board). I didn't sit down and plan it that way, but rather I made my rank list based on my gut feelingf from the interview days. I felt as though I had really enjoyable and fascinating conversations in psych program interview days - and that translated into preferring those programs over peds programs (no offense to the Peds). So, I chose psych for the conversations with patients, coworkers, and "myself," i.e. the concepts I get to think about and consider as I learn how to be a psychiatrist. (And eventually, when I learn to be a child psychiatrist. But... One step at a time)
 
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So, why I chose psych. I applied to pediatrics, psychiatry, and triple board. I interviewed at programs of all three types and I ranked all three types of programs. I ended up ranking psych programs at the top (one exception, Brown Triple board). I didn't sit down and plan it that way, but rather I made my rank list based on my gut feelingf from the interview days. I felt as though I had really enjoyable and fascinating conversations in psych program interview days - and that translated into preferring those programs over peds programs (no offense to the Peds). So, I chose psych for the conversations with patients, coworkers, and "myself," i.e. the concepts I get to think about and consider as I learn how to be a psychiatrist. (And eventually, when I learn to be a child psychiatrist. But... One step at a time)

Interesting! Good luck in your endeavor. I am sure you will be very pleased with your selected specialty.

I chose the field because I wanted to work with patient populations that others might not want to work with. I also chose it because of the ability to practice while maintaining the option of having a great work life balance. Outpatient usually can have a higher functioning patient population, but many times you are on call 24/7. Inpatient has more acute patients, but when you leave work, you usually don't have to be on call unless you are assigned coverage.

Awesome!!
 
Lots of things drew me to psych. Initially it was my M3 inpt rotation. It just wasn't what I expected in a great way and I found I really loved the science behind the field (especially psychopharm). Great lifestyle field, which is important to me as I want to actually know my kids and be able to be there for them. Job security- there's a true shortage of psychiatrists almost everywhere and we have a lot of bargaining power when it comes to job opportunities right now. The other big thing is flexibility and variety. There are sooo many things you can do as a psychiatrist and many of them don't require you to do a bunch of fellowships (or even 1) to do them. It's one of the few fields where you can truly set up an independent PP and do well or even do cash only well. You can do inpt or outpt or both. You can consult, do forensics, addiction, work with any age group, and specialize in a variety of modalities. You can also change what you do or how you practice without having to go back and do a ton of extra training and I like the idea of not being pigeon-holed for my entire career if I decide I don't like what I'm doing.

Just a lot of things that lined up with what I wanted out of life that I didn't really expect. Yes, you need to be able to treat a certain type of patient and not everyone can. If you are able to though, it's a great field (or at least I still think it is so far!).
 
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If the above post were true one would think you would lean more toward orthopedic surgery. Psychiatry is one of the lower paid specialties, but has a high need. Weird, huh?
 
If the above post were true one would think you would lean more toward orthopedic surgery. Psychiatry is one of the lower paid specialties, but has a high need. Weird, huh?

Depends
 
If the above post were true one would think you would lean more toward orthopedic surgery. Psychiatry is one of the lower paid specialties, but has a high need. Weird, huh?
It's pretty well reimbursed these days- average salaries have climbed by 100k+ in the past fifteen years, which has made the specialty much more appealing. But if you want to make bank, it is easier to far surpass the average salary by putting in anesthesiologist or surgeon hours to earn anesthesiologist or surgeon pay
 
If the above post were true one would think you would lean more toward orthopedic surgery. Psychiatry is one of the lower paid specialties, but has a high need. Weird, huh?

The psychiatrists in my group earn between $400K and $600K, and several work at two locations.You can definitely earn as little or as much as you want in psychiatry. National averages are weighed down by folks who work limited hours.
 
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While ortho and derm are constantly on their feet, I get to lounge in a comfy chair.

While ob is constantly on call, I get to sleep without interruptions.

While rads holes up in a cave, I am able to gaze out my window.

Instead of being in a germ infested hospital, I get to decorate my own relaxing office.

Lastly, I basically get paid to listen.
 
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Not to mention the difference in malpractice insurance etc
 
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The psychiatrists in my group earn between $400K and $600K, and several work at two locations.You can definitely earn as little or as much as you want in psychiatry. National averages are weighed down by folks who work limited hours.

Oh my gosh......
I had no idea. 200k is average where I am at (40hrs). Meanwhile ortho surgery is 500k, and the ortho guy I know works 40h/week typically. Works rarely any overtime but he has seniority.
 
In addition, psychiatry being at the bottom of the physician burnout scale among all specialties.

It is also one of the rare specialties that can do telehealth and work from home in your pajama pants.
 
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Oh my gosh......
I had no idea. 200k is average where I am at (40hrs). Meanwhile ortho surgery is 500k, and the ortho guy I know works 40h/week typically. Works rarely any overtime but he has seniority.
I could be wrong, but doubt psychiatrist making $400K+ per year are working 40 hour weeks. If they are it's a lucrative cash based outpatient clinic, or a busy but "efficient" inpatient job with a huge census. Maybe there are other work settings in psychiatry that could generate that much, but I can't think of any.
 
We have busy and efficient inpatient work, busy and efficient partial program outpatient work, in addition to busy and efficient ECT and coverage of an emergency dept using telepsych. At our awesome hospital we have all of these varied forms of practice that keeps work interesting and engaging. I couldn't be happier. I only spend half a day here plus time at night writing notes from home. Our facility is in a well-to-do location in California. The incomes are real. In our part of town, the orthopods earn much more than 500K.

In med school, I thought psych only earned 200K too. But here's the thing, probably the majority of psych jobs out there is around 250K. I probably have a unique situation, but psychiatrists working 2 inpatient jobs is typical out here so incomes are high. You can make $300K from one inpatient job you know.
 
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We have busy and efficient inpatient work, busy and efficient partial program outpatient work, in addition to busy and efficient ECT and coverage of an emergency dept using telepsych. At our awesome hospital we have all of these varied forms of practice that keeps work interesting and engaging. I couldn't be happier. I only spend half a day here plus time at night writing notes from home. Our facility is in a well-to-do location in California. The incomes are real. In our part of town, the orthopods earn much more than 500K.

In med school, I thought psych only earned 200K too.
Psych types tend to keep pay closer to the chest than ortho. Average in non-academics for 40 hours a week is 270k in my neck of the woods, but most people are earning more than that by doing a few part time gigs that pay far more for just over full time hours. I don't know any psychiatrists personally that only have one job, they're all hustling and making out very well doing so.
 
We have busy and efficient inpatient work, busy and efficient partial program outpatient work, in addition to busy and efficient ECT and coverage of an emergency dept using telepsych. At our awesome hospital we have all of these varied forms of practice that keeps work interesting and engaging. I couldn't be happier. I only spend half a day here plus time at night writing notes from home. Our facility is in a well-to-do location in California. The incomes are real. In our part of town, the orthopods earn much more than 500K.

In med school, I thought psych only earned 200K too. But here's the thing, probably the majority of psych jobs out there is around 250K. I probably have a unique situation, but psychiatrists working 2 inpatient jobs is typical out here so incomes are high. You can make $300K from one inpatient job you know.

You're describing the exact scenario I hope to find myself in after residency, in my home state too no less. Mind if I bother you for a job in about 3 years?? :happy:
 
In addition, psychiatry being at the bottom of the physician burnout scale among all specialties.

Chair at the program I interviewed at today was joking that psychiatrists never retire. Then he was like... "No I'm serious, I know guys in their 80's that are still working part time. Some stopped because they started getting demented."
... awkward silence...
 
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I could be wrong, but doubt psychiatrist making $400K+ per year are working 40 hour weeks. If they are it's a lucrative cash based outpatient clinic, or a busy but "efficient" inpatient job with a huge census. Maybe there are other work settings in psychiatry that could generate that much, but I can't think of any.

It's not all that hard to make 400k. I worked with an attending in med school who charged $200/hr cash only and worked less than $40/wk. He netted over $400k/yr (before taxes, after overhead). That's also a pretty reasonable cash only price. Head to major metros and some people charge $400-500/hr. Plus if you're willing to work 55-60 hrs per week you can do it in most places.

You're describing the exact scenario I hope to find myself in after residency, in my home state too no less. Mind if I bother you for a job in about 3 years?? :happy:
Don't mind at all! PM me anytime :)

This is another great example of why I like the field. I've found a lot of docs help each other out and there's not much competition for jobs/patients d/t the shortage (may change, but for now is great). I had 2 attendings tell me to call them when I finished residency if I was interested in a job and since starting intern year I've already had 3 companies call me trying to recruit me and I haven't even put my info out there other than on LinkedIn. There's just a lot of opportunity and I think most of the psychiatrists I've worked with look out for each other.
 
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There are days I ask myself that very same question. Most recently, more often than not.
 
Every thread about why psychiatry turns into a thread about money lol, people chose psychiatry because it’s the best field in medicine if you are interested in mental illness. You get to connect with the patient in ways unlike any other field. Does psych make the most money? No not even close but who the hell cares. Do what you love and if you love mental illness and really diving deep into someone’s life it’s quite a rewarding field with decent pay and lifestyle.
 
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It's not all that hard to make 400k. I worked with an attending in med school who charged $200/hr cash only and worked less than $40/wk. He netted over $400k/yr (before taxes, after overhead).
($200/hr) x (40 hrs/wk) x (52 wks/yr) = $416,000/yr. Yet you said he worked less than 40 hrs per week, and he probably didn't work these hours every single week. Plus you said he made over $400k after then taking out overhead. I'm not saying it's not easy to make a lot of money, but these numbers don't add up.
 
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($200/hr) x (40 hrs/wk) x (52 wks/yr) = $416,000/yr. Yet you said he worked less than 40 hrs per week, and he probably didn't work these hours every single week. Plus you said he made over $400k after then taking out overhead. I'm not saying it's not easy to make a lot of money, but these numbers don't add up.

Hmmm, you are correct. I need to go back and find my previous post about him from when I was in med school. Did a more thorough breakdown then and I could have sworn his gross was ~430k. His overhead was tiny though, a little over 1k/mo total and only had a part-time office assistant. Regardless, he was still making over $250k/yr after taxes and everything else working less than 40 hr weeks. Which is pretty cush imo.

Edit: He also had a side-gig which required a few hours a month and paid okay. Won't get into what it was to much because it's pretty unique, but it's probably not something he could do if he were working more hours without making other major sacrifices.
 
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It took less than 10 posts for this thread to turn into money.

Does psych make bank? Yupp.

But guess what. You better have the passion to deal with really really mentally ill people and not let it get to you..

I will be honest here. I have talked to many close psychiatrist mentors around and they tell me that their mental health has definitely been altered through the trauma and sheer depressing things they have seen people go through.

It has definitely made me reluctant to pursue psych but I will let my rotation decide for me.

People mention burnout being lowest in shrinks... but their suicide risk is also the highest in the field.

Please pursue this field if you have a passion for mental health. Everybody wants "lifestyle"... which is great... but the moment you start looking at your patients in dollar signs, you are heading down a terrible path for you and your patient.
 
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People mention burnout being lowest in shrinks... but their suicide risk is also the highest in the field.

Can you provide source? I was able to find a study from 1979 stating there is no difference in suicide rates between general population and psychiatrists. ncbi.nlm.nih.gov/pubmed/516127 I could have missed some newer studies. Thanks.
 
Do what you love and if you love mental illness and really diving deep into someone’s life it’s quite a rewarding field with decent pay and lifestyle.

You have a very ideal mindset which is great since it provides the motivation to propel forward into the field. Reality may be quite a bit different though.

Modern psychiatry does not offer much of an opportunity to "really" dive into someone's life (however when it does happen it can also be exhausting at points). That sounds more along the lines of psychotherapy which for the most part will play a very limited role in your day-to-day unless you are of the minority who chooses a cash-based practice. 20-30 minutes of face-time (i.e. the typical medication management appointment) only allows you time to go so deep, depending on the patient and his circumstantiality. Get ready for lots of redirection in conversation (as the clock ticks away) so that you can properly assess a thorough ROS in order to tailor/adjust the medication regimen, i.e. the reason your patient sits in front of you as opposed to simply seeing his therapist who gives about an hour of talk therapy each week (vs your Q30 to Q90 day assessment).

The grind is real. Get ready for it.
 
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($200/hr) x (40 hrs/wk) x (52 wks/yr) = $416,000/yr. Yet you said he worked less than 40 hrs per week, and he probably didn't work these hours every single week. Plus you said he made over $400k after then taking out overhead. I'm not saying it's not easy to make a lot of money, but these numbers don't add up.
Usually you end up making more than your regular hourly rate, as initial intakes are often billed at a higher rate per hour ($300-350/hr). Each intake boosts overall income. Overhead in psych is often negligible, in the very low two figures.
 
Usually you end up making more than your regular hourly rate, as initial intakes are often billed at a higher rate per hour ($300-350/hr). Each intake boosts overall income. Overhead in psych is often negligible, in the very low two figures.
I don't think any of these factors make up enough for the fact that this person works less than 40 hours per week and probably has at least some days off in the year. Again, I'm not disagreeing that it's easy to make money, but the post I quoted had some numbers off.

Also, my office is insurance based but we charge more per hour for follow ups than for intakes. I don't actually know which is more common.
 
It took less than 10 posts for this thread to turn into money.

Does psych make bank? Yupp.

But guess what. You better have the passion to deal with really really mentally ill people and not let it get to you..

I will be honest here. I have talked to many close psychiatrist mentors around and they tell me that their mental health has definitely been altered through the trauma and sheer depressing things they have seen people go through.

It has definitely made me reluctant to pursue psych but I will let my rotation decide for me.

People mention burnout being lowest in shrinks... but their suicide risk is also the highest in the field.

Please pursue this field if you have a passion for mental health. Everybody wants "lifestyle"... which is great... but the moment you start looking at your patients in dollar signs, you are heading down a terrible path for you and your patient.

Good points here.

Psychiatry is so different, so unique, and potentially so disturbing, that med students will be making a big mistake jumping headlong into it without several rotations and any additional exposure. Be honest with yourselves. Always listen to your gut. If lifestyle and high income are important, but psych feels like a bad fit for you, then go pursue other specialties that have good income and lifestyle. This may sound obvious, but someone has to say it.
 
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That sounds more along the lines of psychotherapy which for the most part will play a very limited role in your day-to-day unless you are of the minority who chooses a cash-based practice. 20-30 minutes of face-time (i.e. the typical medication management appointment) only allows you time to go so deep, depending on the patient and his circumstantiality. Get ready for lots of redirection in conversation (as the clock ticks away)

Cash psychiatry as a % of psychiatrists has been steadily growing. Id argue that it is sustainable in most mid-sized cities and above. Psychotherapy can be as big a % if your practice as you like, for better or worse.

Grinding it out in a high volume practice may be more lucrative, but I prefer lower volume. While my weekly hours may decrease as I age, I don’t envision ever completely retiring.
 
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People mention burnout being lowest in shrinks... but their suicide risk is also the highest in the field.

Keep in mind, that many fields attract individuals who can relate/have experience with it. I'd be willing to bet that psychiatry has a higher percentage of people who have suffered from some form of mental illness (typically depression/anxiety) than most other fields, if not all. So it would make sense that there would be more suicides in a field with a higher percentage of depressed individuals.

I have no data to back this up offhand. However, pretty much all of my attendings have expressed this sentiment and one or two have even gone so far as to say that it's incredibly rare to find someone in the field with no psychiatric pathology of some form.
 
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I have no data to back this up offhand. However, pretty much all of my attendings have expressed this sentiment and one or two have even gone so far as to say that it's incredibly rare to find someone in the field with no psychiatric pathology of some form.

I am finding it rare to find people in general who don't have some form of pathology. Personality disorder traits seem to run amok. Medicine is no safe haven either. Your attendings have spent a disproportionate amount of time around his colleagues in psychiatry relative to other fields allowing them to reach such a conclusion.
 
Good points here.

Psychiatry is so different, so unique, and potentially so disturbing, that med students will be making a big mistake jumping headlong into it without several rotations and any additional exposure. Be honest with yourselves. Always listen to your gut. If lifestyle and high income are important, but psych feels like a bad fit for you, then go pursue other specialties that have good income and lifestyle. This may sound obvious, but someone has to say it.
Reread this med students. Even if you have a genuine interest it will be extremely challenging at times and test your mettle. Do not delude yourself into thinking that psychiatry is the best fit given so-called lifestyle factors. If your gut factor gives you a sense of second thoughts/hesitation, LISTEN! Choose something else if this is the case.
 
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I will be honest here. I have talked to many close psychiatrist mentors around and they tell me that their mental health has definitely been altered through the trauma and sheer depressing things they have seen people go through.

This sounds like it could be vicarious trauma. Psychotherapy providers can get this. Ethically it is important to monitor your own experience and find your own help when need be, because if you as a provider are struggling, then the way you provide treatment to patients who are struggling may be altered.

This is a general message for everyone here. Just a friendly reminder.
 
Prevalence of Major depression is like 7%. NIMH » Major Depression.

Now consider that folks go in and out of it, I bet the % of the population that has met criteria at some point of their life is significantly higher than 7%.

It's like 18% for anxiety. Data on behavioral health in the United States
And from the APA link above, 'any mental illness' is like 25% of the population... That's a helluva lot!

re: psych affecting providers' mental health. I've met with a ton of attendings and residents that have a therapist of their own and they recommend it. Important to decompress somehow.
 
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Prevalence of Major depression is like 7%. NIMH » Major Depression.

Now consider that folks go in and out of it, I bet the % of the population that has met criteria at some point of their life is significantly higher than 7%.

It's like 18% for anxiety. Data on behavioral health in the United States
And from the APA link above, 'any mental illness' is like 25% of the population... That's a helluva lot!

re: psych affecting providers' mental health. I've met with a ton of attendings and residents that have a therapist of their own and they recommend it. Important to decompress somehow.

I would argue that most people with an MDD or anxiety diagnosis are not mentally ill. DSM diagnoses are not actually natural kinds - remember that reliability and validity are seperate concepts. Not that those people won't benefit from therapy and maybe even a medication, but if you are committed to saying that the lived experience of 1 of 4 people is pathological I think you need to start examining the basis of your definitions. Additionally, while DSM diagnoses are very reliable when assessed via structured interviews or in research studies, the structure of the payment system for healthcare in this country should make you very skeptical about whether these sorts of numbers reported based on charted diagnosis are sonething you want to hang your hat on.

This is a deeper conceptual and philosophical issue here about our nosological system that reasonable people can disagree about but cannot be resolved by appeal to statistics premised on the definitions of that system.
 
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I would argue that most people with an MDD or anxiety diagnosis are not mentally ill.

Considering you need to add a diagnosis in order to bill through insurance I would venture to say there is a great deal of folks being inappropriately diagnosed.
 
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Why can't people have brief periods of mental illness for things such as anxiety and depression? Just because you got pneumonia once doesn't mean that you'll always have it. It just means that 'oh dang there was this one time when my lungs hated me'.

This dichotomy of how we think about 'mental' vs 'physical' illness still perplexes me. More than 25% of people have had a run in with gastro or the cold... we don't consider them somehow tainted because of it.

Imho, this reads more like a social/stigmatized view of the construct of mental illness, no?
 
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I would argue that most people with an MDD or anxiety diagnosis are not mentally ill. DSM diagnoses are not actually natural kinds - remember that reliability and validity are seperate concepts. Not that those people won't benefit from therapy and maybe even a medication, but if you are committed to saying that the lived experience of 1 of 4 people is pathological I think you need to start examining the basis of your definitions. Additionally, while DSM diagnoses are very reliable when assessed via structured interviews or in research studies, the structure of the payment system for healthcare in this country should make you very skeptical about whether these sorts of numbers reported based on charted diagnosis are sonething you want to hang your hat on.

This is a deeper conceptual and philosophical issue here about our nosological system that reasonable people can disagree about but cannot be resolved by appeal to statistics premised on the definitions of that system.

That is so well said. Thank you for putting into words something that has always bothered me and I couldn't quite articulate myself.
 
Why can't people have brief periods of mental illness for things such as anxiety and depression? Just because you got pneumonia once doesn't mean that you'll always have it. It just means that 'oh dang there was this one time when my lungs hated me'.

This dichotomy of how we think about 'mental' vs 'physical' illness still perplexes me. More than 25% of people have had a run in with gastro or the cold... we don't consider them somehow tainted because of it.

Imho, this reads more like a social/stigmatized view of the construct of mental illness, no?


It is trivially true that our current nosological categories are socially constructed. I would strongly suggest you read a good history of the DSM creation process to get a sense of how utterly contingent and arbitrary the categories we work with today came to be. Many examples along the lines of "most people on the committee wanted things to be this way, Robert Spitzer didn't like it, so it was this way instead" or "no one really thought this was a good way to do this, but Donald Klein felt slighted, and so it was done that way after all." The DSM categories are not induced from empirical data; though there is a robust literature that does attempt to induce diagnostic categories from comprehensive symptom surveys, it very rarely ends up inferring categories that clearly map onto the DSM!

A major problem with applying a medical model built around the paradigmatic case of infectious disease to problems of human cognition, emotion, and behavior is that none of the axiomatic bases that make that model work so well for, say, tuberculosis obtain. For almost no psychiatric disorders (or at least that are currently within the psychiatric wheelhouse) do we have a clear mechanism of disease, with a clear etiology, with a clear pattern of response to treatment that is relatively specific to that disease process. Sure, trauma does seem to set people up for PTSD, but those same traumatic experiences can also raise the risk of bipolar I, schizophrenia, eating disorders, OCD, etc, and, inversely, all of those things can happen without any significant trauma history whatsoever. Whereas you simply cannot have TB without the presence of significant numbers of mycoplasma tuberculosis somewhere in your body. ID people obviously consider risk factors all the time and these are very important in epidemiological research, but the fact that, say, being homeless puts you at higher risk of getting TB is not used as part of the definition of TB. That is because the illness entity is defined independently of the environmental factors that happen to accompany it given the social and economic conditions that exist in the world. We're not even close to this for the entities we work with.

(the observant will remark that this applies mutatis mutandis to many chronic diseases that are controversially treated by FM/IM folks, such as T2DM, obesity, chronic MSK pain, etc; those who are even more observant will notice that these conditions are "managed" rather than "cured" and that there is a huge effort to teach PCPs to use techniques originating in psychotherapy to address these, and will perhaps allow me to pass over them in silence for now).

Instead, with the kinds of problems we deal with, we are essentially identifying patterns of beliefs, attitudes, behaviors, perceptual experiences, and cognitions and saying "these things are simply not a healthy part of the human experience and as a society we should definitely devote significant resources to eradicating them, because we said so." Yes, the DSM has their little caveat about distress or impairment, but this is so far from an objective standard as to be ludicrous on its face as a useful criterion for separating out What is Pathological from What is Merely Weird or Inconvenient. We rely on the moral weight of our pronouncements to label things as pathological or non-pathological, so I think it is incumbent upon us to apply a relatively conservative definition to what we are comfortable calling an illness and applying a medical model to. When you examine literature about the extent to which many non-symptom related factors determine who gets what kind of diagnosis (e.g. being black is an independent risk factor for being diagnosed with schizophrenia v. bipolar or psychotic depression), I think you are forced to this position if you are interested in intellectual integrity. A cursory examination of the history of Things We Thought Were Disorders in the Barbaric Past But We Are All Perfectly Enlightened Now supports this. I will not go into the history of homosexuality being in the DSM until shockingly recently, drapetomania, the original origin of the idea of "passive-aggression" etc.

That said, clearly there are patterns of symptoms and experiences that go together that are often associated with having a really profound impact on someone's life. Some of these patterns of symptoms are strongly heritable and are in large part attributable to genetic influences. And people have to live in reference to society in some way or another, so socially constructed ideas are definitely going to interact with these in meaningful ways! So there are some psychiatric entities in the world that are probably Dingen an sich. It is this category of things that I take to be the class of mental illnesses per se.

Your gastro and cold examples are actually perfect. The symptoms involved are definitely real - people are not lying about their experience. They are caused by something, in this case one of approximately a billionty viruses. And they can certainly cause distress. But in 99% of cases, these are not medical problems. You deal with them at home, drink lots of fluids, blow your nose a lot, maybe take a day off work, stock up on OTC remedies that have often never been compared systematically to placebo. Sure, there are some prescription agents that you might actually get some relief from, maybe/probably. There are clearly ways you can feel better. And they can set you up for developing uncontroversially medical problems. But I think it is not at all unreasonable to ask if we want to talk about these as disease states or illnesses v. "something that is obnoxious or distressing that happens to people sometimes."

The worry is that if you make 1 in 4 people pathological on very shaky grounds, you are attempting to abolish negatively valenced human experience, which, fine, if you want to be a hardcore utilitarian might be defensible, but is very different from anything I want to be a part of.
 
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I agree with your post except for 2 parts:

(the observant will remark that this applies mutatis mutandis to many chronic diseases that are controversially treated by FM/IM folks, such as T2DM, obesity, chronic MSK pain, etc; those who are even more observant will notice that these conditions are "managed" rather than "cured" and that there is a huge effort to teach PCPs to use techniques originating in psychotherapy to address these, and will perhaps allow me to pass over them in silence for now).
I don't think they should get away just passing over this. I think migraines in particular are a good analogy to psychiatric disorders, yet many people view them differently.

Your gastro and cold examples are actually perfect. The symptoms involved are definitely real - people are not lying about their experience. They are caused by something, in this case one of approximately a billionty viruses. And they can certainly cause distress. But in 99% of cases, these are not medical problems. You deal with them at home, drink lots of fluids, blow your nose a lot, maybe take a day off work, stock up on OTC remedies that have often never been compared systematically to placebo. Sure, there are some prescription agents that you might actually get some relief from, maybe/probably. There are clearly ways you can feel better. And they can set you up for developing uncontroversially medical problems. But I think it is not at all unreasonable to ask if we want to talk about these as disease states or illnesses v. "something that is obnoxious or distressing that happens to people sometimes."
These are certainly illnesses even though they're minor. I don't really understand your argument otherwise.
 
I agree with your post except for 2 parts:


I don't think they should get away just passing over this. I think migraines in particular are a good analogy to psychiatric disorders, yet many people view them differently.

I agree with you; I felt my post was long enough as was without getting into that issues as well. Based on ethnographic studies about adherence and meaning-making around long-term anticonvulsant medications (setting aside the frankly psychiatric symptoms sometimes coming along with it) I think us having nothing to do with epilepsy is maybe a mistake.

These are certainly illnesses even though they're minor. I don't really understand your argument otherwise.

Rather than quibble over the particulars of that word, I will say only that the main thrust of what I meant was that the classical medical model had almost nothing to offer colds or most viral GI bugs. I am not sure if that is a point we disagree on or not.
 
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