Some Questions about the Field

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BlueLensFlares

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Hi all!

I didn't know if to place this in the pre-med section or not, but it seemed better for this section.

So I'm a rising third year philosophy major (only had calc, chem and hume, will be taking bio and chem this year) and I've recently considered going to medical school (specifically for psychiatry) for different reasons - first, I believe everyone has a right to be happy, and it seems to me that it's a relative stable profession financially, and I haven't really had that financial stability growing up. It seems like since I want to be financially stable, and I believe others have a right to be happy just as much (which commands me to help others when I can), it's nice to help others and myself in the same process. I really love science and I want to find solutions to some ethical problems with its usage, and I find mental health extremely interesting.

In the Fall I'm planning to volunteer/work in a mental health clinic somewhere near my school. I have no idea what the work is gonna be like... I have this strange (perhaps common) fear of those society has deemed crazy, but I guess they're just people who have difficulties in trying to be happy and living their own lives. And maybe the label "crazy" is a little misconstruing and demeaning. I have some family with mental issues, and I see mental problems as being really difficult to understand and make sense of, but really important to address since it seems to me that it is in one's mind where one lives. So, I just have some questions about the whole thing.

First, do I seem like I have the right attitude/motivation to be in the field? I know it will be very difficult and stressful at times, but my school and home life is (in my opinion) unusually challenging and has exposed me to how difficult academic life can be. So that's one thing; but what about the motivations/intentions that I have? I've had family who have gone to professional school and done poorly because they didn't go in with the right mindset or motivation about the profession, and I find that horrifying since the financial investment is so large for medical school. Maybe the volunteering and shadowing experience I'll try to obtain in the Fall would be of some help.

Secondly, and this is broader - it seems like certain behavioral patterns are deemed dysfunctional or disorderly when they inhibit one to function "normally" or to fulfill daily tasks. Like OCD, Bipolar Disorder or Depression. But is it fair to deem a behavior as disorderly or defective only because of the social norms that are in place that concern daily living skills? I'm just wondering if for instance, a person who has depression because he always thinks about people suffering in the world, and how messed up the world is, or hopeless, is really dysfunctional, despite his attitudes, in my opinion, being largely correct, and his behaviors perfectly rational given his beliefs about the state of the world. I don't know.

Anyway, I don't really have any sensible intuitions about the field since I haven't really done anything in it. I bought Listening to Prozac and hopefully it will be a good read - it's gonna be my first written exposure to the field. Any suggestions about the first or second questions, where I should explore more about the field (places, articles or books that have very limited medical terminology, since I know nothing past general chemistry), what to take in mind before investing so much money into medical school, or any other suggestions would be great.

Thanks!
 
Just to address your second question, the difference between a "quirk" and a "disorder" is a phrase you see repeated many times in the DSM--"clinically significant distress or impairment", so it's more than just determining what is socially appropriate or not.
 
A LOT of people are afraid of the mentally ill because they don't understand them. You can learn to be comfortable with them if you want to.
When I was a 3rd year med student doing my very first psych rotation, I remember being kind of scared of one of the patients they gave me (a schizophrenic who reported hearing auditory hallucinations in the voice of his case worker telling him to kill people). Nowadays, I've seen that kind of thing so much, and I have a much better understanding of A) how to safely interact with such patients and B) what I can do to help them that it's not scary anymore.

As for the person who is depressed about the state of the world, as OldPsychDoc mentions, it's really a question of impairment. If someone is so depressed by thoughts of starving children in Africa that they can't get out of bed, take a shower, find the motivation to feed themselves, or go to work, then that's a disabling problem that needs to be addressed. With many of my patients, yes, they may have a reason for being depressed, but they're not coping in a healthy and functional way with the depressing event.
Of course, in cases where the person is not an imminent threat to themselves or others, I often ask patients how much they perceive their symptoms as being a problem. If someone has some weird belief that's harmless to others and doesn't cause them distress, no, they may not need treatment. However, there are many folks out there struggling with mental illness who desperately want help and actually are grateful to get it (especially in outpatient psychiatry - in inpatient psychiatry you have many more people who are there involuntarily due to concerns about safety and aren't necessarily happy to be there).

Here are some books about mental health that I recall reading and enjoying as a layperson:

"Night Falls Fast: Understanding Suicide" by Kay Redfield Jamison (a psychologist who has bipolar disorder herself)
http://www.amazon.com/Night-Falls-Fast-Understanding-Suicide/dp/0375701478/

"The Boy Who Was Raised As a Dog: And Other Stories from a Child Psychiatrist's Notebook: What Traumatized Children Can Teach Us About Loss, Love and Healing" - some of the stories are disturbing, because it is nature of child psych that often psychopathology in children is caused by the child experiencing a traumatic/disturbing event (for example, I recall descriptions in the book about a sexually abused child trying to be seductive to the psychiatrist because that's the only way to interact with adults that the child had ever known) but I remember the overall tone being rather inspirational in his belief that these kids can be helped.
http://www.amazon.com/Boy-Who-Was-Raised-Psychiatrists/dp/0465056520/

Love's Executioner from Yalom talks about the psychotherapy side of the field, which can be interesting:
http://www.amazon.com/Loves-Executioner-Psychotherapy-Perennial-Classics/dp/0060958340/
 
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Hope this doesn't sound too harsh but I find it extremely naive that a philosophy major would think people have a right to happiness. Rights are meaningless if they cannot be guaranteed, the majority of people are not happy and people have just as much right to be unhappy as to be happy whatever that means. Perhaps you ought to take some classes in theories of justice, virtue ethics, philosophy of mental disorder etc.

Psychiatry has nothing to do with happiness, and if you think that you will be sorely disappointed. Most psychiatrists know little or nothing about how people ought to live their lives, or what constitutes a good life or wellbeing. That is much more in the field of philosophy.

Those patients who come to us wanting to be happy leave sorely disappointed because it is a meaningless, amorphous, and totally subjective concept. These people have difficulty being specific about what they want out of life, or even why they want to be happy. Even Freud's aim for psychoanalysis were less auspicious, he simply wanted to "transform hysterical misery into common unhappiness". It was a blind naivete about the limits of psychiatry's role that partly brought American Psychiatry into disrepute by the 1970s. This was to be repeated in the 1990s during the rise and fall of the psychopharmacological revolution when the new SSRIs promised to be panaceas for every psychic woe, when it turns out they don't even help that much for depression!

The "right" reasons - I am not sure what they are, but going into psychiatry because you want to make people happy is a "wrong" reason, going into any medical field for that reason is idealistic guff, we can't even promise a "right to health" (As most people do not have "health" as defined by the world health organization).
 
You can, very importantly, help relieve suffering as a psychiatrist which is invaluable. I suggest approaching medicine more from that angle.

Happiness? People have desires. Often those desires are harmful.
 
Maybe I should refine what I meant by happiness. I didn't intend happiness to be this euphoric, utopiastic feeling that people have been searching for the entire history of humanity, but I think of it rather as a catch-all term to describe what it is that people need. Another poster said to be free from suffering - maybe that's closer to what I intended. This is because I have absolutely no idea what form happiness would even take on in the first place - is it a feeling, is it the existence of certain environmental circumstances regardless of the individual's state of mind... etc. I don't know what happiness even is, but I use it as whatever it is people ultimately desire, I guess. Since all actions are done for some purpose, the ultimate purpose maybe.

But then, I'm sort of still struggling then at that point what the purpose of psychiatry is. A previous poster stated that people don't have a right to be happy. So then what is the relationship of the human being to happiness? Not a right but a privilege? Or, is it that psychiatry doesn't even touch the concept of happiness, has nothing to do with defining/finding happiness in the individual, but focuses on making sure the individual has the physiological abilities to seek happiness for himself, which requires the individual is healthy. Is this a more accurate description of the field? To be honest, I was little taken aback when other posters stated that psychiatry has little to do with happiness. This is because it seems like everything every action we do we do for some end, and so every action becomes an end in itself, leading up to the final end, which is good in itself, which seems like to me happiness.
 
First off, I'm glad you broached the subject as you raise some interesting thoughts. Here's my two cents. Psychiatry, like every medical field, in a crude sense does bring happiness to others and those who practice it. The comments on here address a reality about the pursuit of happiness and it's philosophic implications that are difficult to achieve and realize. We all know this.

But make no mistake, psychiatry is immensely needed. Just walk around the wards of any hospital and see the very high percentage of sick people who also have depression, or anxiety, or even psychotic features. We come to their rescue. Doctors call on us to evaluate and treat patients inhibited by mood disorders, psychotic disorders, unexplained changes in cognition and behavior. Psychiatrists must have a command of toxicology and addiction, and must understand how to recognize and treat these patients. Psychiatrists pursue pain management as well (some even direct pain fellowships - even at Harvard I think). We do so much that you will find something fascinating, challenging, and enjoyable somewhere in the field of psychiatry. It's probably why so many doctors change fields into psych. We must master medical knowledge of the body obviously, but also master knowledge of mental disorders, toxicology, pharmacology, basic neuroscience, neurologic disorders, essential psychology, and psychotherapy. In other words, any time the behavior, awareness, or cognition of a patient veers beyond normal, psychiatrists are there to save the day.
 
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relieving suffering and being free from suffering are different. psychiatry is not about ensuring people are free from suffering, rather that people are able to endure it. bad things happen. we experience pain, emotional and physical. our lives would be the poorer for it if we did not. when someone we love dies, it hurts. but it hurts because we loved and know what it is to love, and thus to experience loss and the pain the comes with it. the patients we tend to see have difficulty enduring suffering, which compares to those of us who experience suffering but have learned how to cope with it without become completely overwhelmed and disabled.

rights are meaningless if they are things which cannot be guaranteed or even aspired to. it is meaningless to say that people have a right to be happy, when that is not something that is in anyone's control and that psychiatrists can do anything about. and like i said, if we have a right to be happy, don't we also have a right to be unhappy? perhaps this is something you can explore further in your philosophy classes or for your thesis?
 
While I basically agree with that: i.e. psychiatrists are doctors who specialize in treatment of specific kinds of illnesses, there's a "systems" level function that most psychiatrists fulfill these days, in terms of care coordination, practice management, quality improvement, research, etc.

To address the concerns of the original poster: while it's commendable that an undergrad is starting to think about very deep things that don't have good answers to, being a practicing psychiatrist is TOTALLY not what you think it is. It's about being a doctor. And being a doctor today is about having a solid knowledge base, being efficient and thorough, knowing the system, caring about patient's welfare, and becoming a leader and valuable and practical member of a team.

There is very little in being a doctor that requires deep pontification and things of that nature. So if you find that following protocols, being efficient and team work to be not what you like, then I think being a doctor is not the kind of career you want.

michaelrack said:
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities. http://en.wikipedia.org/wiki/Psychiatry

The purpose of psychiatry, like other medical specialties, is to treat illness- the type of illness that psychiatrists treat is mental illness.
Click to expand...
 
sluox said:
It's about being a doctor. And being a doctor today is about having a solid knowledge base, being efficient and thorough, knowing the system, caring about patient's welfare, and becoming a leader and valuable and practical member of a team.
Click to expand...

This is why I love being a doctor. Well said. 👍
 
BlueLensFlares said:
Or, is it that psychiatry doesn't even touch the concept of happiness, has nothing to do with defining/finding happiness in the individual, but focuses on making sure the individual has the physiological abilities to seek happiness for himself, .
Click to expand...

anhedonia (inability to experience pleasure) is a primary symptom of depression, and is also seen in schizophrenia. So I guess you could say that a small part of what psychiatrists do is assist patients in regaining the ability to experience pleasure.
 
michaelrack said:
Psychiatry has little to do with making people happy. I would encourage you to explore the field of psychology (although they too might not think their job is to make people happy).
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Wow-you must be in a pretty miserable part of psychiatry. I treat patients with good ego-strengths who are still miserable and depressed, or anxious etc. WIth therapy and medications, they consistently get "happy" and improve back to their normal functioning. This is the best part of my practice and being a psychiatrist. I am here to help people be happy and get well.

If you are a psychiatrist and not in the field for that, then you must be miserable. I guess if you are doing forensic evals or CL or something but any type of adult psychiatric practice revolves around improving ones mind, body and overall well-being aka "happiness"
 
Tripolar said:
Wow-you must be in a pretty miserable part of psychiatry. I treat patients with good ego-strengths who are still miserable and depressed, or anxious etc. WIth therapy and medications, they consistently get "happy" and improve back to their normal functioning. This is the best part of my practice and being a psychiatrist. I am here to help people be happy and get well.

If you are a psychiatrist and not in the field for that, then you must be miserable. I guess if you are doing forensic evals or CL or something but any type of adult psychiatric practice revolves around improving ones mind, body and overall well-being aka "happiness"
Click to expand...

1. I do not equate euthymia with "happiness".

2. I am board certified in Internal medicine, Psychiatry, and Sleep Medicine (through the ABIM); I am also certified in Psychosomatics. 99% of what I do now is sleep medicine, primarily treating sleep apnea. CPAP therapy does improved body and mind (improved cognition and mood); I guess by your definition I am making my patients happy (although some aren't happy initially to get the CPAP machine).
 
Tripolar said:
Wow-you must be in a pretty miserable part of psychiatry. I treat patients with good ego-strengths who are still miserable and depressed, or anxious etc. WIth therapy and medications, they consistently get "happy" and improve back to their normal functioning. This is the best part of my practice and being a psychiatrist. I am here to help people be happy and get well.

If you are a psychiatrist and not in the field for that, then you must be miserable. I guess if you are doing forensic evals or CL or something but any type of adult psychiatric practice revolves around improving ones mind, body and overall well-being aka "happiness"
Click to expand...

I didn't have the courage to say this myself, but I am glad you did so that I can agree with you whole-heartedly. Furthermore, as much as I can appreciate the philosophical problems people have raised with the concept of "happiness", I don't think it is fair to suggest that its ambiguity prevents it from being a legitimate therapeutic aim.
 
SmallBird said:
I didn't have the courage to say this myself, but I am glad you did so that I can agree with you whole-heartedly. Furthermore, as much as I can appreciate the philosophical problems people have raised with the concept of "happiness", I don't think it is fair to suggest that its ambiguity prevents it from being a legitimate therapeutic aim.
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Lot's of people made me happy today, including the person at McDonald's who served me my hamburger. To my knowledge, only one of them was a psychiatrist (my wife). Saying you want to go into psychiatry to make people happy is like saying you want to be a doctor to help other people.
 
SmallBird said:
I didn't have the courage to say this myself, but I am glad you did so that I can agree with you whole-heartedly. Furthermore, as much as I can appreciate the philosophical problems people have raised with the concept of "happiness", I don't think it is fair to suggest that its ambiguity prevents it from being a legitimate therapeutic aim.
Click to expand...
I guess you missed my post in which I stated that I did not consider euthymia (which is an important therapeutic goal) to be the same as happiness. In another post I stated that the relief of anhedonia is a goal of psychiatrists.
 
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