Moo, or Mew?


“Should a patient be treated with counseling or with medication?” is a common question. A psychiatrist conversant in Zen Buddhism would answer, “mu“. This answer is a Zen technique for unasking the question. It means that the question is not valid. Both counseling and medication are important aspects of treatment. Outcome research in patients with mood disorders consistently indicates that illnesses respond fairly well to counsel alone, better to medication alone (at times), but best of all to counseling and medication used together. The same is true for patients with anxiety disorders, bipolar disorder, and schizophrenia.

In some disorders, such as obsessive-compulsive disorder (OCD), a specific form of counseling known as cognitive-behavioral therapy (CBT) has very specific and long-lasting benefits. The best results occur in patients treated with CBT and with specific medications for relieving certain symptoms of OCD.


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Apples and Oranges

What is the difference between a psychologist and a psychiatrist? 

A psychologist may have a Bachelors degree after 4 years of college (BA, BS), a Master degree after another 1 or 2 years (MS Psy, MS Psychol, &c), or a Doctorate degree after another 2 to 3 years (PhD, PsyD &c). A psychologist studies human behavior, both normal and abnormal, and may specialize in psychological testing (psychometrics) or specialize in testing for subtle types of brain damage (neuropsychological testing). Clinical Psychology is another special area of study wherein psychologists are trained to specialize in counseling. Generally, there is little or no medical training, and limited or no training in use of medications. The number of patients seen during training is typically limited to less than twenty.

A psychiatrist must finish 3 or 4 years of college taking required scientific training in Biology, Chemistry, Physics, and Advanced Mathematics, and earn a Bachelors Degree in the areas of study. This is followed by 4 years of medical school to earn an MD or DO. After the first two years, and after the second two years, national certifying examinations (from the National Board of Medical Examiners, Parts I and II) must be passed before the person can advance in school. Usually, this is followed by a one-year internship, spending six or more months in training in Psychiatry. This is followed by Part III of the National Boards certifying examination; it too must be passed in order to continue further in the training. The new physician then enrolls in a 3-year residency in Psychiatry, spending all three years caring for patient with psychiatric illness. This occurs on hospital services and outpatient services, as well as in special clinics. This may then be followed by a one to three year fellowship in any of the subspecialities in Psychiatry, including Psychopharmacology, Child Psychiatry, Forensic Psychiatry, Oncology Psychiatry, and Geriatric Psychiatry. Until recently, it was necessary to have two years of clinical practice before the certification examination in Psychiatry could be taken; it may now be taken after completion of residency training or fellowship. If this test from the American Board of Psychiatry and Neurology, Inc. is passed, the doctor is said to be Board-Certified. During the years in training, usually hundreds of patients are seen under supervision from many different psychiatrists. About 50% of psychiatric inpatients and 25% of psychiatric outpatients have physicall illnesses related to or causing their psychiatric symptoms; having medical school training is very helpful. Because psychiatrists are physicians, they have a broad perspective, incorporating relevant aspects of physical illness into diagnostic and treatment processes.

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What is Mental Health?

The term “mental” comes from the early 15th century, from the Middle French word mental, from Late Latin mentalis “of the mind,” from Latin mens (genitive, mentis) “mind”. In turn this comes from the IndoEuropean base stem *men– “to think” (confer Sanskrit matih “thought, mind,” Gothic gamunds, Old English gemynd “memory, remembrance,” Modern English mind (n.)).

“Health” comes from the Old English word hælþ meaning “wholeness, a being whole, sound or well,” again from an IndoEuropean word *kailo-  meaning “whole, uninjured, of good omen” (confer Old English hal “hale, whole”; in Old Norse it is heill “healthy”; from the Old English halig, the Old Norse helge “holy, sacred”, and ultimately the Old English word hælan “to heal”). [Source: Online  Etymology Dictionary]

Mental health is a state of uninjured wholeness of mind. A common legal definition of mental health is that it is the absence of mental disorder, defect, or disease. Another way to define mental health is that it is optimal functioning of the mind. These definitions are self-referential and can be easily attacked. To say mental health is what we declare it to be is silly.

What is Mental Illness?

“Mental Illness” is equally difficult to define: an acquired loss of statistically normal thinking, feeling, and/or perceptual experience. Some mental illnesses have clear biological underpinnings and identifiable brain pathology. Some reflect the interaction of changes in genes with the environment. Some occur in ways that reflect the effects on the brain of a physical illness. Unfortunately, most of this kind of evidence remains detectable only with highly refined instruments. At present, descriptions of mental illness reflect careful summaries of abnormal behavior symptoms that cluster together in carefully-defined populations. These definitions have been studied at length in patients with the conditions, and the definitions are improved every five to ten years. Suggested definitions are published in books, the most accepted of which is one released in 2013 from the American Psychiatric Association, known as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A sixth edition is forthcoming in a few years.

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