A Psychiatrist

For the curious, to be a psychiatrist in the United States you must first become a licensed medical doctor (MD or DO). So, a college degree, premed classes, four years of medical school, then a year of internship in a hospital to get your general license to practice medicine. Then follow it up with three additional years of specialized training in psychology, psychotherapy, and the medical causes and treatments for mental health conditions. The four years after medical school are called “residency”, which is a kind of on-the-job training. After you complete your residency in an approved residency program, you are officially a general psychiatrist.

Although the types and amounts of psychotherapy training and experience vary between programs, I think its fair to say that any modern psychiatry program will provide extensive experience and training in the various medical conditions which can cause mental health problems, the uses and mechanisms of action of currently available psychoactive medications, and the medical and psychological side effects which can be caused by those medications. These are the forte areas of psychiatry, and I would say the majority of referrals to psychiatrists arise for their expertise in these areas.

In addition to general psychiatry, there are various subspecialties such as child psychiatry, consult-liaison psychiatry, forensic psychiatry, and others. Child psychiatrists, of course, work with children; and while a general psychiatrist can also work with children, to call yourself a “child psychiatrist”, you should complete a one or two year additional “fellowship” training in addition to the usual four year psychiatric residency.

Consult-liaison psychiatrists are the “hospitalists” of psychiatry. Generally they work in hospitals helping to manage patients who have a prior history of mental illness or are newly exhibiting psychiatric issues while there. Similar to child psychiatry, general psychiatrists often do consult-liaison work, although fellowship programs have been created to further credential consult-liaison psychiatrists.

Forensic psychiatrists work with the criminal justice system. Evaluating defendants and testifying in courts, or working in prisons and jails with inmates who have psychiatric issues, are examples of the work they do.

I went in to psychiatry feeling it to be a “bridge” discipline, spanning the mental health field from humanist psychotherapies to neurology. And I still feel that is what psychiatry should be.

However, psychiatry is being pushed towards being a primarily biological discipline, perhaps due to peer pressure from the rest of the medical establishment, which is heavily invested in the systematization of knowledge and the scientific method.

While there is much to be said for that approach, there are other realms of human experience, interpersonal and subjective, which that approach is poorly suited to deal with, but which are supremely important to mental health and psychological healing.

As a result, psychiatrists are becoming more and more adept at resolving psychiatric symptoms using biological approaches and becoming less and less adept at fostering actual psychological healing.

I see this site as serving two purposes: First, as an educational resource for the general public interested in psychiatry and psychiatrists, and secondly, as a forum for me and others to voice their suggestions and concerns regarding mental health in general, and psychiatry’s role in the future of health care.

If you have opinions to share, I look forward to hearing from you.