The Identity Crisis Within Psychiatry

A common retort I hear as a psychiatrist from new patients when I ask them to expand on their stories is “oh, it’s ok- that is just therapy stuff” implying that since I am just the drug gal, my role is, well, to give them their drugs. Most are a little taken-aback, but pleasantly surprised when I respond, “if I don’t know YOU and what’s going on in YOUR life, I can’t possibly make a good medication recommendation.” There’s no such thing as being just the drug gal.

It would be easy to blame this misconception on a few lame psychiatrists who help reinforce our reputation as “pill pushers”, but it’s more complicated than that. Our field is in a chronic identity crisis. While we want, need, and deserve our respect as physicians (because, yes, I DID go to medical school), we must claim and own our space within the social sciences, the psychological, and the narrative histories. This is because the truth is we can’t diagnose your depression with just a physical exam, lab finding, and/or checklist of symptoms-my most crucial diagnostic tool is your story. 

And when we do diagnose your depression, we need to stop conceptualizing it as purely a diagnosis. Rather, it serves our patients more to understand their own intricate combinations of lived experience and biology. If your husband died last week, if you were abused as a child, or if you recently had an insidious onset of extreme lethargy and sadness-all may present with the same symptoms on a questionnaire in my office, but the treatment approach may be vastly different. The nuance is not only helpful, but is imperative to do our job right. 

So yes, our profession is distinct. It is medical, but not purely medical and it is psychologic but not solely psychologic. By not embracing our unique identities as psychiatrists, we are doing a disservice to our patients. A marker of a good psychiatrist is, in my opinion, a rejection of the existence of a “just the drugs” person and a dedication to knowing their patient beyond the metaphorical prescription pad (fun fact- everything is electronic now). Only then can we move away from simply trying to eliminate a symptom to treating the whole person, with their own personal brand of suffering, in front of us.