WHy do people hate and distrust Psychiatrist?

[kg062008]

Hi, i'm a M1 who has interest in psychiatry. However there are these forums everywhere bashing psychiatry saying it is a pseudo science, all psych's are crazy, evil, etc. There are all these groups trying to discredit psychiatry as a medical specialty. Why are people this hostile toward the psychiatric profession?

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[splik]

This could easily be 'why do people hate and distrust physicians?' because I think you will that that are many many people who believe that doctors are evil, they are arrogant, they put their own interests before those of their patients, suppress the evidence for treehugging, reiki and homeopathy, created HIV to kill black people, are witholding the cure for cancer, advocate useless vaccinations to line the coffers of pharma and hide the truth that they cause autism and death (or mental ******ation according to Michele Bachman), and that we are all corrupted by our own greed and opulence and like nothing better than lording our power over sick people. You will find people who believe that doctors cause more problems than they treat (read Medical Nemesis), people who believe that obstetrics is a travesty and obstetricians have no role in the natural process of childbirth, that neonatology is a travesty, and I could go on... It is unsurprising that a profession that is so often regarded as saviors, can so easily be portrayed as abusers!

I have met these people and they are scary!

It is valid for medical students to have these concerns about psychiatry, but if you really care what people think about you maybe medicine isn't the career for you period. The majority of the US population no longer believe physicians are highly trustworthy (nurses narrowly beat doctors in the trust polls). Politicians are always attacking the medical profession.

Psychiatry has a long history of abuse (as has medicine) with individuals incarcerated for no clinical reason receiving barbaric treatments such as lobotomies and unevidenced based treatments like bowel resections, blood transfusions, tooth removal, insulin comas, extremely high doses of unmodified ECT and there are a vast number of competing theories to explain psychopathology (cognitive, behavioral, biological, psychodynamic, existential, social realist, social constructivist, nihilistic, humanistic etc) which historically has divided psychiatry. Many of these problems are in the past today.

Unfortunately there is still a lot of misinformation about mental illness, which some people see as purely moral, spiritual, or social in origin (some of it is, most of it isn't) and so the medical formulation and treatment of 'deviant behavior' often is very emotive.

Psychiatry is not a science, but neither is medicine. It is however informed by the scientific method - we make observations, develop hypotheses based on those observations, test those hypotheses, collect the results and interpret and make inferences about the meanings of those results. That is what science is. psychiatry is increasingly evidence based and we use epidemiological methods to try and better classify and understand the causes of mental illness. Randomized controlled trials and meta-analyses are used to evaluate the treatments. There is a burgeoning literature on the genetics of severe mental disorders such as schizophrenia (for example we now know ~1% of schizophrenia cases can be explained by large chromosomal microdeletions) and cognitive neuroscience is helping us understand the neural basis of emotion and cognition both normal and abnormal.

Now we are not as advanced in our understanding of pathology, or clinical treatments as epidemiology, but we are far ahead of most of chronic disease management, pediatrics, obstetrics, and many surgical specialties in terms of evidence base for clinical practice.

Most people don't hate psychiatrists, but there are those that do. Then again there are those who hate all physicians in general.

 

[dl2dp2]

What's interesting to me is that when you go do your 3rd year rotations, you'll notice that most of the patients you meet on psychiatry are much more friendly than patients you meet on other rotations.

You develop a much deeper rapport in psychiatry, and your patients more often than not genuinely appreciate you, and more often than not get better, albeit slowly. For these reasons and some others, psychiatry has one of the lowest mal practice insurances.

So I guess to answer your original question, most of your patients don't hate you. In fact, most of them tend to really like you. And in private practice you often have the option of choosing the patients that you like the most. Hope all of this soothed some of your concerns.

The profession has a lot of issues. Some meds are overprescribed. Others aren't sufficiently prescribed. Pharma need to be more transparent. Residual influence of the witchcraft days of psychiatry prior to neuroscience. Etc. But changes are slowly coming. RDoC, neuroimaging, evidence based psychotherapy, etc. It's a hopeful, forwardlooking specialty that is interesting and has a good life style.

 

[cbrons]

I think a lot of it has to do with history and many "old school" people seeing true psychopathology as simply a case of odd & benign behavioral idiosyncrasies.

 

[whopper]

Medical school is biased against psychiatry because so much of it hyper-focuses on the physiological processes going on and downplays the behavioral aspects such as good bedside manner.

Most of the professors in medschool have no behavioral science training. It's like putting a bunch of engineers together at a party and one psychologist. The engineers will all talk Star Trek, Fortan, and Linux, and telling people to go into their field, not psychology.

Psychiatry is also a field where diagnosis is heavily laden on clinical opinion more heavily than labs. Non-psychiatric medical doctors often forget that several "physiological' pathologies also use clnical diagnosis. The science and technology is not to the point where diagnosis is done by labs. Several physicians frown upon this ignoring several pathologies that are based too on clinical observation such as temporal arteritis. (Don't argue that diagnosis is by biopsy. Biopsies can only confirm this diagnosis. A negative biopsy can still be temporal arteritis). In fact, we could actually diagnose several forms of mental illness in a more gross and "acceptable" manner to our physician colleagues if ethics (e.g. take out a person's brain and slice it up), cost, and availability of PET scans weren't an issue.

Unfortunately, psychiatry IMHO is now in something of a stage of development similar to diabetes before sugar levels could be taken--when diagnosis had to be based on clinical observation because the diagnostic equipment wasn't yet there to measure sugar levels. This is because mental illness most likely deals on a level even smaller than that of the cell, but that of the second messenger systems, RNA interactions, multiple brain circuits interacting in ways not even fathomed, and several other reasons. We're dealing with something far more sophisticated than non-mental illness in terms of the physiological processes going on. I'd liken this to a microchip vs. a the vacuum tube primitive computers.

What we do know leaves a lot to be desired, but enough to make a positive difference in most cases. Antidepressants for example, in studies, do work but don't work well. Antipsychotics for most patients will improve quality of life but it won't be as good as it was before the psychosis started for many. We have few cures, only treatments.

Throw into the mix the stigma of mental illness with even several medical doctors having prejudice against the mentally ill, that mental illness is a weird phenomenon for many, and that many professions within medicine bash each other (surgeons vs. anesthesiologists, ER doctor vs. any inpatient doctor, Peds vs. Ob-Gyn).

As an attending I get pretty much zero disrespect as a psychiatrist from my physician peers with plenty of them begging me to work for them because they have too many patients with psychiatric issues needing help. I currently work in a psychiatric hospital and here the psychiatrists have higher standing than the non-psychiatric doctors. In medical hospitals some physicians bash psychiatrists, but the bashing is pretty much all-around with every profession bashing a different one.

 

[Sneezing]

How would you respond if someone just told you today that your mind/brain/behavior/mood was abnormal?

Unless your pathology has disrupted your life enough that you can't hide from it anymore, you will tell that someone to eff off. Some of those people are more vocal then others, and that's where the disdain for psychiatry comes from.

Are we perfect? Nope. But overall we do make a difference in people's lives and when you care, read, observe, research and practice, people will get control of their lives again. It feels good to contribute towards that.

 

[Ibid]

How would you respond if someone just told you today that your mind/brain/behavior/mood was abnormal?

.... and that's where the disdain for psychiatry comes from.

.

Agreeing with the erudite posters above and what you have said hear is very true as well. It is not the underlying theories that people object to as such but more often the language of pathology.

Everyone is used to words having a medical and a legal meaning but usually they also have a lay meaning. So when you say disease, what you really mean is not the same as what your lay patient understands or presumes you mean. (usually).

As you imply it shouldn't be a surprise that people take offense when it is implied that their personhood is "diseased" just to take one word.

Sadly it is not just some psychiatrists that cling to words as if accuracy was more important that a patients wellbeing. Plenty of psychologists, nurses, social workers and advocates are more interested in maintaining the percieved purity and "rightness" of their chosen explainitory frame work than they are in secondary effects on their patients.

Imo it is usually very easy to find words that are equally accurate but are less offensive but for some people using the language of pathology seems to be a point of honour as much as anything.

btw The fact that many people recieve interventions against their will has not been mentioned yet but that is another matter.

 

[F0nzie]

I've had very positive experiences with random folks asking about my profession. It's a pretty good ice breaker actually.

I've had the following responses:

"Oh really? that's funny you say that because I had the weirdest dream last night!"

"Uh oh! You need to talk to my wife" *husband points at wife*

"You know my son is in high school, and lately he's been getting into a lot of trouble..."

"I better watch what I say or you're going to analyze it right? HA HA!"

Some days I'm not interested in sparking conversation and I don't mention my true profession if they ask. But so far my experience has been that people really want to talk to you if they know you're a psychiatrist.

 

[DD214_DOC]

I've had very positive experiences with random folks asking about my profession. It's a pretty good ice breaker actually.

I've had the following responses:

"Oh really? that's funny you say that because I had the weirdest dream last night!"

"Uh oh! You need to talk to my wife" *husband points at wife*

"You know my son is in high school, and lately he's been getting into a lot of trouble..."

"I better watch what I say or you're going to analyze it right? HA HA!"

Some days I'm not interested in sparking conversation and I don't mention my true profession if they ask. But so far my experience has been that people really want to talk to you if they know you're a psychiatrist.

This. My wife is a lot more social than I am (I'm perfectly happy hiding in my hermit house) and all of her friends know what I do. Most are pretty cool, but there's always 2-3 who think they can stop by for random therapy sessions or bug me on the weekend with their problems. I had to put a stop to that nonsense pretty quickly. I told them if they want to talk to a friend, they're welcome to come talk to my wife, but I'm not getting involved in any of their problems.

I have only had one person who basically never talked to me again after finding out what it is I do and stopped letting his children play with mine. Not sure what to think about that one.

 

[InBoston]

Medical school is biased against psychiatry because so much of it hyper-focuses on the physiological processes going on and downplays the behavioral aspects such as good bedside manner.

Most of the professors in medschool have no behavioral science training. It's like putting a bunch of engineers together at a party and one psychologist. The engineers will all talk Star Trek, Fortan, and Linux, and telling people to go into their field, not psychology.

Psychiatry is also a field where diagnosis is heavily laden on clinical opinion more heavily than labs. Non-psychiatric medical doctors often forget that several "physiological' pathologies also use clnical diagnosis. The science and technology is not to the point where diagnosis is done by labs. Several physicians frown upon this ignoring several pathologies that are based too on clinical observation such as temporal arteritis. (Don't argue that diagnosis is by biopsy. Biopsies can only confirm this diagnosis. A negative biopsy can still be temporal arteritis). In fact, we could actually diagnose several forms of mental illness in a more gross and "acceptable" manner to our physician colleagues if ethics (e.g. take out a person's brain and slice it up), cost, and availability of PET scans weren't an issue.

Unfortunately, psychiatry IMHO is now in something of a stage of development similar to diabetes before sugar levels could be taken--when diagnosis had to be based on clinical observation because the diagnostic equipment wasn't yet there to measure sugar levels. This is because mental illness most likely deals on a level even smaller than that of the cell, but that of the second messenger systems, RNA interactions, multiple brain circuits interacting in ways not even fathomed, and several other reasons. We're dealing with something far more sophisticated than non-mental illness in terms of the physiological processes going on. I'd liken this to a microchip vs. a the vacuum tube primitive computers.

What we do know leaves a lot to be desired, but enough to make a positive difference in most cases. Antidepressants for example, in studies, do work but don't work well. Antipsychotics for most patients will improve quality of life but it won't be as good as it was before the psychosis started for many. We have few cures, only treatments.

Throw into the mix the stigma of mental illness with even several medical doctors having prejudice against the mentally ill, that mental illness is a weird phenomenon for many, and that many professions within medicine bash each other (surgeons vs. anesthesiologists, ER doctor vs. any inpatient doctor, Peds vs. Ob-Gyn).

As an attending I get pretty much zero disrespect as a psychiatrist from my physician peers with plenty of them begging me to work for them because they have too many patients with psychiatric issues needing help. I currently work in a psychiatric hospital and here the psychiatrists have higher standing than the non-psychiatric doctors. In medical hospitals some physicians bash psychiatrists, but the bashing is pretty much all-around with every profession bashing a different one.

Additionally, I know many people (conservative generally) who do not trust psychiatrists, because they think they are liberal and will tell their children it's "okay to be gay", etc.

Believe it or not, some people just don't like the idea that they can't set the norms of what people should be.

 

[Saluki]

Additionally, I know many people (conservative generally) who do not trust psychiatrists, because they think they are liberal and will tell their children it's "okay to be gay", etc.

Believe it or not, some people just don't like the idea that they can't set the norms of what people should be.

I had written a longer response, but I'm afraid of getting burned at the stake. Basically, although I don't agree with the views of those families, I think you're on shaky ground when you start telling an adolescent patient that the family's deeply held religious beliefs are wrong.

 

[pysch4sure]

I'm on OBGYN right now, waiting on a baby. 20 min ago the father tells me how awful doctors are, and how he wished that his midwife would've taken vacation at some other time. They're not your granola-eating types either, they seem pretty normal.

So to echo Splik and others, some people don't like doctors in general, and many times it goes deeper than that.

Many distrust the medical establishment with good reason. Look up Willow Brook for starters, there were psychiatrists in on that too.

And you don't have to go back very far to see unethical gov't-sanctioned medicine. I was happy to see that a certain bearded terrorist met a grisly end, but I was devastated to find we used a fake vaccine program to locate him. It's this kind of shady work that taints our profession, and sets back effective public health programs for at least a generation.

Some of the flak we get is perfectly understandable. All we can do is act ethically and hope that our good behavior will win people back.

 

[classof2011]

I've had very positive experiences with random folks asking about my profession. It's a pretty good ice breaker actually.

I've had the following responses:

"Oh really? that's funny you say that because I had the weirdest dream last night!"

"Uh oh! You need to talk to my wife" *husband points at wife*

"You know my son is in high school, and lately he's been getting into a lot of trouble..."

"I better watch what I say or you're going to analyze it right? HA HA!"

Some days I'm not interested in sparking conversation and I don't mention my true profession if they ask. But so far my experience has been that people really want to talk to you if they know you're a psychiatrist.

In love with this post because its so true. I've only been experiencing the opposite of what this. I guess it may have something to do with the overall outlook of our country in general; the recessions, weird natural disasters, random acts of violence from unsuspected members...Once people find out I'm going to be a psychiatrist they literally spill their guts...What I love more is that they will flat out tell me things that they wouldn't even tell the people they consider closest to them.

"Hey doc, you think my penis not getting as stiff anymore has something to do with all the stress I've been having lately? I'm too ashamed to tell my primary care doctor in case he thinks Im crazy, but hey, you seem to be a master in figuring out who is and who's not, right?"....This happened to me at a party not too long ago. It was when I realized how much pride I should take in the profession that I've chosen.

So I dont know about that, OP. Many may openly bash Psychiatrists (like they used to do Black people, Gay people, Jewish people, pick your next bandwagon) but deep down it seems that most of us wish we had someone to talk to and to guide the healing of life's imminent problems.

 

[notdeadyet]

One reason not mentioned is that there are truly a lot of terrible psychiatrists.

While many/most med students end up going into psychiatry for the best of reasons, we can't escape the fact that as one of the least competitive specialties out there, our field is also a dumping ground for folks who have applications that make almost any other field outside the realm of possibility. This is also why you get some truly awful family practice docs.

I've had a couple of friends whose opinions I trust see psychiatrists and relate some pretty terrible stories of mismanagement and poor interpersonal skills. When you have someone who is struggling to just pass medical school and get into ANY residency, psychiatry is often one of those choices and in some of the practitioners it shows.

 

[BobA]

I completely agree with Notdeadyet's above post. I've gotten referrals from and heard stories about many psychiatrists that I wouldn't trust. This usually has to do with (1) over-medication and (2) poor interpersonal skills.

We all need to be humble and keep in mind that psychotropics have serious drawbacks and should be prescribed judiciously.

 

[PETRAN]

I think i've read a while back (maybe it was in a Carlat post-im not sure) that only a 30-smthng% of people trust psychiatrists-less so than bankers (!). Trust for general internists was around 70% i think. Clearly there is something going wrong there. Maybe the fact that scientology and a lot of new-age crap are pushing for spiritual and natural "healing of te soul", maybe the "evil past" of psychiatry and Hollywood portraying torture with ECT and lobotomies, maybe the over-prescriptions of drugs and the sometimes-realy-bad side-effects of heavy polypharmacy, maybe the "chemical imbalance" as shown by big pharma advertising (people using that as a justification of the "science-less" of psychiatry whereas modern models talk about dysregulated neural-circuits and synaptic transmission/plasticity problems rather than problems with the "chemicals" per se, people have difficulty understanding that and for this big pharma is to blame i think)maybe the non-scientific descriptions of DSM at some times appearing silly and foolish, maybe the low percentage of really good psychiatrists (in comparison to other medical professionals-thats what i see anyway)...



probably a combination of all these (and a few more) takes credit away from psychiatry. You guys need to gain (more) trust. This is partly for clinical psychology as well, although people in general are more positive towards psychology. The fields of "mind sciences" are generally much less understood by the general public in comparison to other scientific fields. Attitudes towards these fields are governed by the popular media rather than actual science-this is a big problem IMO.

 

[Daftrage]

Petran, your statistic from Carlat sounds like it was made up, I would think the significantly lower risk of malpractice is a better measure of trust than a blog post.

Second some of your other points make it seem as if you don't really have any experience in other realms of medicine. For example if you think Psychiatry is bad about polypharmacy then then you must never have worked in primary care. I have taken care of multiple patients at the VA who were on 15 plus meds, only one or two of which were from psych.

 

[PETRAN]

Petran, your statistic from Carlat sounds like it was made up, I would think the significantly lower risk of malpractice is a better measure of trust than a blog post.

Second some of your other points make it seem as if you don't really have any experience in other realms of medicine. For example if you think Psychiatry is bad about polypharmacy then then you must never have worked in primary care. I have taken care of multiple patients at the VA who were on 15 plus meds, only one or two of which were from psych.

No, i don't think that malpractice is a good measure of public opinion, since it is only restricted to mental health patients who are usually in great need of help. Ofcourse, if you have chronic stress o tortured by voices and a doctor treats that, the patient is going to be of gratitude etc. This is about public opinion not my opinion or a lot of patients opinion for that matter.


Again, with polypharmacy its the same, this is the general opinion, that psychiatrists are mostly "pill-pushers". Is it justified? I don't have evidence of this, although i think that a younger person that is put on many antipsychotics/ anti-depressants/anxyolytics would look "bad" to the lay-person, possibly due to possible bad side-effects (sedation, sexual/pleasure stuff) in comparison to e.g., an older person with multiple medical problems treated with other kinds of drugs. I have experience with neurology since i'm doing neuropsych practice in a neuro ward and i can see what you say in older individuals. Maybe this is not similar to a 20-year old person with severe anxiety treated agressively with multiple agents (benzo+SSRI+SNRI+something else-even antipsychotic for augmentation). I know that not every psychiatrist is like that but i get the impression that many are (maybe i'm wrong). Anyway, thats what it looks like to the "public" from what i have gathered so far. I don't think that the poll's results were very far removed from reality (maybe it was 38% or something.)

 

[notdeadyet]

Petran, your statistic from Carlat sounds like it was made up, I would think the significantly lower risk of malpractice is a better measure of trust than a blog post.

Psych's lower malpractice rates have a lot more to do with the fact that we don't wield scalpels or apply treatments that can immediately kill patients if our diagnostics were wrong. The public doesn't have particular love or respect for dermatologists either; the malpractice has to do with the kinds of work we do.

That said, those public opinion polls are pretty weak. Judging the level of respect folks have for psychiatrists can be significantly altered from week to week based on a documentary or Time cover story that appeared the night before.

 

[Daftrage]

Psych's lower malpractice rates have a lot more to do with the fact that we don't wield scalpels or apply treatments that can immediately kill patients if our diagnostics were wrong. The public doesn't have particular love or respect for dermatologists either; the malpractice has to do with the kinds of work we do.

That said, those public opinion polls are pretty weak. Judging the level of respect folks have for psychiatrists can be significantly altered from week to week based on a documentary or Time cover story that appeared the night before.

I'm not saying it is a good measure, just a better one than a random poll on a blog.

 

[InBoston]

One reason not mentioned is that there are truly a lot of terrible psychiatrists.

While many/most med students end up going into psychiatry for the best of reasons, we can't escape the fact that as one of the least competitive specialties out there, our field is also a dumping ground for folks who have applications that make almost any other field outside the realm of possibility. This is also why you get some truly awful family practice docs.

I've had a couple of friends whose opinions I trust see psychiatrists and relate some pretty terrible stories of mismanagement and poor interpersonal skills. When you have someone who is struggling to just pass medical school and get into ANY residency, psychiatry is often one of those choices and in some of the practitioners it shows.

See? Psychiatry is the buttcrack of medicine. Stinks up the whole place.

 

[Leo Aquarius]

Until you experience your first psychotic break, then who will you beg to save you?

I love the hypocrisy - people are quick to condemn. And then that day comes when you or your friend needs psychiatric help. The day will come.

 

[PETRAN]

Until you experience your first psychotic break, then who will you beg to save you?

I love the hypocrisy - people are quick to condemn. And then that day comes when you or your friend needs psychiatric help. The day will come.

Agreed. But people who have never experienced a mental-health problem (or a person close to them) are having a hard time to understand that and it is easy to fall pray to whatever alternative crap exists out there. The lack of education towards what mental health services rally are, (wrong) misconceptions about psychotherapy and pharmacotherapy and a general lack of kowledge for the sciences of the mind in general magnify the problem (and as i said some of these causing problems to psychology as well).



I agree with notdeadyet on the aspect that law suits have little to say on opinions. I have the impression that neurosurgeons are highly praised by anyone, being considered as some-kind of demi-god or something yet they have very high malpractice rates (maybe the highest?). Because, one may think that the neurosurgeon is some kind of a "genius superhuman" but when someone close to you (or you) is unfortunate enough to become a neurosurgical patient and you have very high demands on them, ignoring the fact that there is a high chance that you may be left permanently paralyzed, mute, comatose or even dead, well, opinions change.


It is true, opinions change, but i'm not sure that more general attitudes change so easily in general. I have the impression that overall, attitudes are generaly mostly negative and distrustful towards psychiatry. Just go to Youtube and type "psychiatry", then type "neurology" (just for comparison). See what results come back, seriously. "Psychology" also leads to a 50/50 split between negative and neutral/informative videos. I don't know if scientology or any of that new age crap have manipulated the general public, but it doesn't look pretty. I think that more education of the public is needed (and an improvement of mental health education and services as well).

 

[F0nzie]

I have the impression that overall, attitudes are generaly mostly negative and distrustful towards psychiatry. Just go to Youtube and type "psychiatry", then type "neurology" (just for comparison). See what results come back, seriously.

This is because Scientologists have a marketting campaign against psychiatrists. People who praise our work don't go on YouTube and make videos about how we saved their lives.

 

[freaker]

Additionally, I know many people (conservative generally) who do not trust psychiatrists, because they think they are liberal and will tell their children it's "okay to be gay", etc.

Believe it or not, some people just don't like the idea that they can't set the norms of what people should be.

All societies set norms as to what people should be. The bar is set differently in whatever society you're part of. Where that bar lies is a matter of debate, but I don't think there's any debating it needs to be set and most values can be readily agreed to.

 

[freaker]

I think psychiatry will become increasingly better understood as substance use becomes more and more of a social problem. It tends to be psychiatrists who come behind and clean up the mess of prescription drug abuse. I can't speak for all psychiatristrs, but in my area, psychiatrists, for instance, tend to take more people off of benzos or opiates than put them on them.

There is a huge social cost to substance dependence, and I'm finding it's rare that someone doesn't know someone else who has been addicted to xanax, oxycodone, or alcohol and needed help--often a family member. Shows like Intervention bring these issues and the typically underlying psychiatric problems into the light and into the general cultural parlance.

 

[jettavr6]

Many of you have either experienced this or will experience what I call the boomerang that hits the thrower smack dab in the middle of the face. Example, a certain psychiatry bashing physician that all of a sudden gets a very difficult patient (think borderline), and now needs your help. Or this same type of physician all of a sudden has a family member that needs treatment. Generally, I think the "boomerang effect" nails most psychiatry bashing physicians at some point. And the same applies for any specialty that denigrates another. In private practice it's been my observation that psychiatry is pretty well respected.