What Do Psychiatrists Do?
Posted by Dr. Vollmer on September 16, 2015
We diagnose, and yet, our diagnostic system is flawed, and hurtful to some patients and their families. We treat with medication, and mostly that is helpful, but occasionally it is a means to enforce a misdiagnosis and a misunderstanding of the patient’s psyche. We also treat with machines such as ECT and TMS, and that is also mostly helpful, but without a theoretical basis for clinical improvement. I would like to think that what psychiatrists do, what I was trained to do, is listen. Yes, yes, I am on my soap box, talking about the complexity of listening, the use of listening as a healing device, and the respect we show to patients by listening deeply with a thoughtful and theoretical mind which gives us multiple models in which to listen. How do I market listening? How do I tell the world of drive-by health care that time and patience are the key ingredients to my work. Like cooking a brisket, there is no short-cut. Limiting time kills the value of the product, in that the product is open-ended. Giving the patient “goals” is also antithetical to my model, in that goals imply that the patient comes in knowing what the problem is, instead of my model which says that there is both a stated and unstated, or unconscious, agenda. Marital problems might bring someone to my door, but a hunger for understanding their childhood may keep them coming. If I stated the goal was “marital harmony” then I would miss the opportunity to explore deep-seated feelings which have manifested by displaced anger and aggression. If I shorten my sessions, then I would miss the unpeeling of the onion which only comes after many minutes spent together struggling to understand how the patient suffers. If I speak in terms of “tools” then I miss the point that the patient knows about these tools, but for complicated reasons does not avail himself to them. It is simplistic to expect that short sessions, limited visits and goal setting could overcome lifetime habits of poor decision-making and self-destructive behavior. Why would psychiatrists, those with more training than any other mental health professional, buy into this simplicity? This question represents my struggle. How did we get here? The greed of the 15 minute appointment is one answer, given that it is easy to do the math. Is the answer as simple as that? I think so.