Monday, December 5, 2011

Why Psychiatry is Awesome

A butterfly, the source of the Greek root "psyche"

I love psychiatry. I’m on it now and have a week to go. But I really really love it. There are several reasons why, and I’m going to list them. In no particular order:

1) Patient Relationship
I love psychiatry because it, above all other fields, requires and encourages relationship with patients. There are no physical diagnostic tools in Psychiatry. There are no objective measures, “signs” of depression. It is perhaps the purest field of medicine because there is no technology to aid or hinder the psychiatrist in diagnosis. It is one mind evaluating another. To get to the diagnosis, a psychiatrist must know a patient. In therapy, a psychiatrist uses his mind as a surgeon uses his knife.

I love getting to know my patients, and I love Psychiatry because this is both encouraged and required.

2) Philosophy
I have many interest, and it is always my goal to integrate them as much as possible. I have a long and sustained interest in philosophy, and I had previously given up any serious integration with medicine and philosophy. But when I started considering Psychiatry, I realize that it, perhaps alone among medical subspecialties, has profound philosophical implications. Of course ethics and a general philosophy of medicine might apply everywhere. But seriously, what other field gets to play with Ontology (what actually exists)?

Cardiology is pretty clear: the heart (cardia) is a pump, and we should keep it pumping. But what is soul (psyche) that soul-doctors (psyche-iatros) are trying to fix? Does it exist, or is it a useful fiction? How can it get diseased? What is the best way to heal it? It may well be that practice in psychiatry will yield insight into these questions, or that philosophical insight on these question will suggest changes to psychiatric practice.

3) Interesting Problems
The patients in Psychiatry are downright interesting. This is in contrast to most medical specialties where it is largely the diseases that are interesting. An unusual tumor is interesting, but the patient may be anyone. In psychiatry, there is a relatively limited number of disorders, but an infinite difference in the patient. The disease of schizophrenia may include delusions, but the patient will always have a different and intriguing story. One may think it’s the CIA that is out to get them, another may think it’s the County of Santa Clara. Perhaps it is because of an invention they have, or out of vengeance. What makes a mind do this?

Then there is the who “somatiform” cluster. People go blind, get migraines, feel pain, lose the ability to urinate, get paralyzed from the waist down, all by the power of their mind. As in the Matrix, “Your brain makes it real.” Emotional pain transformed into the physical world. How does that happen?

I love stories and there’s one thing psych patients have it’s stories. For depressed patients, all of them have a different trail of tears, a different Shakespearian tragedy that led them to the psychiatrist.  It is an intriguing thing to get into the mind of a patient, empathizing with a tragic tale (in depression) or suspending disbelief on an assumption or two (in schizophrenia).

4) “New” Field (Lots Left To Do)
There is nothing psychiatrists like to do more than talk about how Psychiatry is a new field. A century or so ago (i.e. when it really was new), Wilhelm Wundt (1832-1920) launched it as an experimental science at about the same time as many physical sciences. But, as Daniel Robinson in “An Intellectual History of Psychology” Modern psychology is in a state of perpetual youth because there hasn’t been dramatic progress like we’ve seen in biology or physics.

It’s a wide open field. On the physical side, we are just beginning to be able to watch a functioning brain with fMRI and PET scans; we have psychoactive drugs that can actually change brain processes that are more recent than antibiotics. On the cognitive side, we have new treatments and paradigms that, for the first time in history (thanks to modern experimental design, statistics, and computing power), can be experimentally verified. From the faith perspective, I know of no one who has successfully wrestled with these concepts and figured out how to fully understand them as a Christian.

Young or old, there’s lots of work to be done. I like the pioneer narrative, and so an ‘unexplored’ field like Psychiatry fits in nicely with the story I’m trying to tell (that is, my life).

5) Lifestyle
One of the totally awesome things about Psychiatry is that you can be a Psychiatrist and you can be other things too. This is not true for surgeons. I suppose some of them sometimes do things outside of surgery. But thanks to Halstead, going into surgery residency is pretty much like going into a monastery. Psychiatrists, on the other hand, seem to have lives. They are married, and make dinner (yes, dinner) plans with their spouses. Surgeons tend not to be able to do this.

And if there’s one thing I have it’s other interests. Research, reading, religion. Global health, philosophy, history. Photography, music, walking. There are a million things that I like to do that are not “my job” and I’d prefer a field where I could continue to do them. Psychiatry seems like it’s chill with all this.


  1. I agree. Rock on, comrade!

  2. This was very satisfying. I have been having troubles on what career suited me, and all the reasons you pointed out largely appeal to me. I feel like I just found my long lost brother, but in this sense it's my profession. Thank you for this post, much love!

  3. very nice and informative post about this fascinating field of medicine, we need more and more people to show the positive side of the field to attract more genuine people into it.

  4. Anon1: Comrade? Are we in Soviet Russia?

    Anon2: I'm glad this has been helpful. It was a lot like meeting someone who was "long lost"; it was like that feeling of a key sliding into a lock.

    Anon3: We do need more Psychiatrists. Way more. And/or a better way to do Psychiatry (I'm workin' on it :)

  5. wow you spoke my mind, I'll list some reasons soon in addition.

  6. Hey, dipshit. Do everyone a big favor and definitely do not become a psychiatrist. Douche bag specialist would work, though.

  7. You are a fantastic psychiatrist! One of nurses's favorite doc!