The science of psychiatry

Psychiatry is an evidence-based medical speciality no different from other branches of medicine

By Dr Prabha S Chandra

Asha, an 11th standard student, had been experiencing spells of fainting and episodes of unusual behavior for a few months. Her family was very worried and had taken her to several temples and faith healers. They were told that she was possessed. Having spent a lot of money and effort in vain, they took Asha to a General Physician (GP) who referred them to a psychiatrist. Her parents were hesitant. Would the psychiatrists give her shock treatment or sleeping pills? Would they hypnotize her? What if they labeled her mad?

When she came to me, Asha looked distressed. She was fed up of being taken to one faith healer after another. Gentle probing revealed that she was facing immense academic pressure in 11th standard and her family’s expectations were weighing down on her. She would panic before each test, and with the final exams approaching, her anxiety had reached its peak. This led to her fainting spells and bouts of odd behavior, and as a result, she wasn’t eating or sleeping well.

A combination of antidepressant medication, teaching Asha better coping skills, discussing the relationship between mind and body, in conjunction with making her understand the family concerns and explaining to her about how stress caused the genesis of her symptoms, led to rapid improvement.

Psychiatry as a medical specialty has evolved considerably in the last four decades. In the 1930s and '40s, most of the treatment was psychological and was done using psychoanalysis (a form of treatment that involves listening to patients in hour-long sessions, which went on for several years, and interpreting problems based on childhood issues and trauma). However, the initial enthusiasm gave way to skepticism, mainly because the treatment was long and recovery was not always certain.

In the 1950s, the first drugs for psychiatric problems were discovered, which radically changed the way mental disorders were managed. Patients who earlier had to be admitted in asylums, were now treated at home and were able to manage a near-normal life in the community.

Since then, there have been major advances both in the understanding of mental disorders and their treatment. Newer and more advanced ways of studying brain function have led to a better understanding of psychiatric disorders. Extensive research has led to the development of new medications and psychological treatments, which can be tailored for specific disorders. This is significant, considering that mental health disorders are now classified as one of the four main categories of non-communicable diseases (NCDs) along with diabetes and hypertension.

What can someone expect when they see a psychiatrist?

A psychiatrist is a medical doctor who specializes in diagnosing and treating mental health disorders using a combination of medication and psychosocial treatments. When you first meet a psychiatrist, they will usually take a detailed history of your existing problems and ask about your childhood, family and previous medical problems. They then perform a physical examination to rule out any medical problems that may be disguised as a psychiatric problem. After that they conduct a mental status examination – here they assess your mood, thought, intelligence, intellectual abilities, look for any other experiences and also assess your own understanding of the problem.

A psychiatrist views the person as a whole, and studies the role of the person and their interaction with the environment that is causing or sustaining the illness or symptoms. The treatment usually involves a combination of medicines and psychological treatment. The family plays a crucial role in treatment. Given this holistic approach, psychiatrists seldom work in isolation; treatment usually involves a team of mental health professionals including a psychologist, social worker and a nurse. Often, a GP may also be involved.

It must be noted that all mental health problems do not require the same level of treatment. The milder problems can be resolved through therapy alone. Some mental health conditions require a combination of medicines and therapy while in more serious mental disorders, medication is essential.  

Also, it is not necessary to seek advice only from a psychiatrist, especially for minor mental health problems such as short-lasting anxiety or brief and mild depression. One may visit a counselor, general physician or another mental health professional.  If necessary, these professionals will then refer you to a psychiatrist.

Myths about psychiatry

Despite the fact that psychiatry is a well-established medical specialty, there are several myths which create barriers to seeking help for mental health problems.

The barriers are related to misconceptions about the cause of the problem, what will work, and what psychiatrists do, fear of medications and hospitalization, stigma associated with meeting psychiatrists, and a view that anyone who meets a psychiatrist will be labeled ‘mad’.

The symptoms of a mental disorder often appear mysterious and difficult to understand, leading people to seek help from faith healers or temples and dargahs.

Some people fear that admitting to feeling depressed or anxious is a sign of weakness and hence do not seek treatment. However, it is essential that one overcomes these hurdles and seeks advice from a mental health professional early. Quite often, the family of the patient reaches a psychiatrist quite late, after having exhausted both their finances and their energy. Delays in seeking treatment can have long-lasting and serious consequences. Symptoms and distress that can be relieved with quick intervention sometimes become chronic due to the lack of information or availability of services.

Fortunately for Asha, she was taken to a GP who referred her to a mental health professional before things could get worse. Now she is able to comfortably manage her anxiety and doesn’t require medications any longer.

Dr Prabha S Chandra is a professor of psychiatry at NIMHANS.  

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