[AMA] I Am a Shrink (Psychiatrist), Ask Me Anything

Hi all, I am working as a psychiatrist. I am happy to answer any questions you may have about the field. Offcourse, I will not be providing any management / treatment of illness as I do not think it is appropriate unless I have assessed a person myself.
For a good online self help resource, people can use MoodGym website.

closed Comments

  • +14

    Shouldn't psychiatrists be able to unlock 100% of their own potential?

    • +65

      I think you're confusing psychiatrist with super saiyan.

      • +2

        This isn't even my final form. Bankai!

    • +9

      Watch the movie limitless

      • -2

        But can't you use your neuroplasticity to ace maths and sweep all the Millenium Prize $1000000 awards? The fear with AI is the intelligence getting into a positive feedback cycle. What has stopped psychiatrists from achieving this already?

  • +11

    All right I'll get the ball rolling…

    • What practical differences are the between Psychiatrists and Psychologists apart from the ability to prescribe medication?
    • Do psychologists refer clients to you or do you get to work with clients straight up?
    • How old are you?
    • Have you always wanted to be a Psychiatrist?
    • If so, when did you know this and if not, what were you doing/studying previously?
    • If you weren't a Psychiatrist, what would your next preferred profession be?

    I realise I've asked quite a few qns, please take your time to answer and thank you for doing this.

    • +20

      The three main differences between psychiatrists and psychologists are:

      Psychiatrists are medical doctors, psychologists are not.

      Psychiatrists prescribe medication, psychologists can't.
      Psychiatrists diagnose illness, manage treatment and provide a range of therapies for complex and serious mental illness. Psychologists focus on providing psychotherapy (talk therapy) to help patients.
      Many people get psychiatrists and psychologists confused with each other.

      Both psychiatrists and psychologists understand how the brain works, our emotions, feelings and thoughts. Both can treat mental illness with psychological treatments (talking therapies).

      However, psychiatrists attend medical school and become medical doctors before doing specialist training in mental health. Because they are doctors, psychiatrists understand the links between mental and physical problems. They can also prescribe medications.

      • What happens if the psychologist thinks that a patient also needs medication? Would they then refer the patient to another psychiatrist to prescribe the medication? And since the psychiatrist can do both, will the patient be transferred to the psychiatrist? Thanks.

        • +5

          A good psychiatrist should do both talking and medication prescribing

      • No verification from mods needed, you speak like a true psychiatrist lmao ;)

        • +19

          And how does that make you feel?

          • @Scrooge McDuck: You know how when you see a wet leaf on a sidewalk and it hardly even registers in your brain? It's around that level of indifference

        • uh oh, looks like someone's in need of a couple of follow up appointments.

      • +1

        Couple of key questions not answered in there.

      • +8

        I'll chime in as a Clin Psych who works in Health and taught at a medical school, it is important to note that:

        Worth delineating between a 'Clinical Psychologist' and a 'Registered Psychologist'. Both have different levels of training, a Clin Psych will have undertaken a 4-year undergrad, 2-year masters, and then 2-year supervised accreditation. A registered psych will have completed at least a 4-year under and 2-years supervised practice. In theory, a Clin Psych should have substantially more training in psychotherapy. However, your mileage may vary and there are some wonderful registered psychologists out there, who have pursued substantive additional training and development.

        Psychologists are trained to conduct a range of assessments i.e most popular cognitive assessments, that psychiatrists can't. There are further assessments that a clinical psychologist can conduct that a registered psych cannot (*sometimes specialist training will mitigate some of the criteria). Further, there are a number of assessments, such as for ASD, that are typically done by psychologists, as they are time/cost-prohibitive/training-limited for a psychiatrist to conduct.

        Psychiatrists typically provide detailed assessment, review and recommendations, while managing the medication component of treatment. They are certainly trained to treat with other approaches (talking therapies). However, psychiatrists treating with talk therapy approaches are not typically the norm, as seeing a psychiatrist week/bi-weekly is simply cost/resource prohibitive (*Evidence suggests conducting therapy with gaps longer than this, is not effective in most contexts). It does, however, happen. Typically, in a service such as NSW Health, you'll have Clinical Psychologists applying psychotherapeutic interventions, with support from consulting psychiatrists.

        Psychologists formulate and diagnose illnesses, this is a core criteria of registration.

        Psychologists should be aware of links between mental and physical problems, they should be trained in biopsychosocial models. Typically it's been a criticism of psychiatry that they were stuck for too long using a biomedical model of mental health: https://jonabram.web.unc.edu/files/2013/09/Deacon_biomedical...

        • Psychologists formulate and diagnose illnesses

          Shouldn't Psychiatrists diagnose and decide on drug therapy and then pass them on to Psychologists who could be trained on certain issues (i.e addiction) for (talk) therapy? Obviously I am talking about those on the more serious scale.
          Seems would be a better division of labor.

    • +1

      All referrals need to come from GPs in private practice. That being said other health professionals may suggest a patient to go and see a psychiatrist.

      Yes always wanted to be psychiatrist. Intrigued by knowing the hidden I.e the mind and how to treat it.

      I like Emergency department specialist with a life full of adrenaline.

      • +5

        Referrals can come from any doctor, and they are not necessary. You just can't get a Medicare rebate unless referred. Referrals from GPs can last longer (up to indefinitely) than referrals from other specialists (up to 3 months).

        The strong push to have referrals by GPs is because, I believe, that there needs to be a doctor coordinating a patient's care, since often there can be many different doctors managing the same patient and, for example, wanting to change their medication regime. GPs tend to see patients more often and know them the best. That's the idea anyway.

        • Yes, I agree

          • +2

            @DiLs: Why do they call you shrinks?

            For the longest time, I haven't seen you guys actually shrink in size. Or use some hypnosis to shrink someone else. Is it because all psychiatrists are bad at laundry? Or are we talking about another type of shrinkage?

    • like the difference between ophthalmologist and optometrist.

      • -3

        The difference cannot be further. The medical scope of an Ophthalmologist far outstrips that of a psychiatrist mostly because of the amount of medical training required to get into the program, then an even more arduous task of graduating from it.

        Psychiatrists on the other hand, often have very limited medical knowledge, and are able to take on the job one year after graduating medical school. Meaning they have only the most basic grasp of medicine.

        • Psychiatrists need to get through a training program that lasts at least 5 years and requires multiple exams and other assessments to be passed. What you've written is quite misleading. I'm also not sure on what basis you claim psychiatrists have "limited medical knowledge" seeing as they have to get through medical school and internship (plus potentially further experience as a resident) just like any other specialist.

          • @zoob: I didn’t mean that to be offensive although I can see how it may come across as rude and dismissive.

            But my experience with consultant and registrar psychiatrists is that they have a limited scope from a medical and surgical point of view - something that they have no problems admitting. I have friends who are interested/have gone into psychiatry, and they often do so the moment they finish their internship (or very close to). While the psychiatry training program may take 5 years, there is a poor focus on organic medical/surgical conditions - which is why they often do not and cannot run or maintain MET calls (resident, registrars and consultants).

            It’s no different to saying that surgeons (and let’s be honest, most physicians too) have limited/no knowledge in psychiatry.

            But to compare a ophthalmologist to psychiatry is not comparing apples to apples. Many ophthal hopefuls will do many years of BPT or surgical residency, or both, incorporating many aspects of different specialties. This just is not true with psychiatry. Thus - limited medical knowledge and even more limited practice of said medical knowledge.

            • @Jaystea: I still don't agree that you're painting a realistic picture and I suspect this is because of the well recognised stigma that exists not only against people with mental illness but those that work with them.

              The ophthalmologists I know have gone straight to registrar service jobs after their RMO years in the main and have very limited medical experience outside of maybe doing ED and ICU rotations (which I also did prior to psychiatry training). Most other surgeons I know eg orthopaedic, general are much the same.

              All psychiatrists have to do consultation liaison psychiatry terms which involves working with medical and surgical patients. Certainly in my experience during training there was a significant focus on neuropsychiatry and when I worked in long term rehab there was a lot of managing medical issues. That included managing MET call situations including cardiac events, seizures etc. Of course in a general hospital I wouldn't be running MET calls, but neither would the ophthalmology registrar (or any surgeon for that matter).

              I don't know whether you're an ophthalmologist and feel the need to inflate your own ego but tearing down your (?) colleagues in a public forum is not the way to do it.

              • -3

                @zoob: Not an ophthalmologist (far from it, have no wishes). Sorry if you feel that I’m tearing your profession down, not my intention.

                Nonetheless, to insinuate that psychiatrists to a general or greater degree know more medical and/or surgical knowledge than the general ophthalmology hopeful is basically the very definition of inflating one’s own ego.

                You cannot be a solely unaccredited ophthalmology registrar (will often take at least two years of medical or surgical RMO training) after internship but you can with psychiatry - the common route taken. Many psych doctors thus don’t even have the most basic of ICU training and management of the deteriorating patient let alone much medical, surgical or emergency experience. This isn’t always the case, but is common.

                Psych docs are one of the only specialties that require very little training before actually training in an otherwise very specialised field that is in many cases quite separate from conventional medicine (compared to medicine, surgery, crit care, radiology, GP).

                It has nothing to do with patients actually, but the above mentioned. I have no ego to inflate nor defend. Just the need to point out that psychiatry is not to psychology as ophthalmology is to optometry. If you cannot see how or why that is, then the only big hurt ego is yours.

  • Do you see other psychiatrists for treatment?

    • Not me personally, but there are psychiatrists who will see other health professionals.

      • Do you think that every troubled person is a victim of their own genetics and environment, or are some people distinctly bad?

        In a commited relationship where abuse is occurring, when/where should one draw the line on compassionate tolerance to instead focus on self preservation?

        Given the mere existence not to mention the prevalence of abuse in dyads, is it folly to enter into a life-long commited relationship such as marriage? I.e. for better, for worse, for richer, for poorer, in sickness and in health, until death do us part.

        • A lot of factors can be involved in the development of an illness including genetics, environment etc.
          You never know the relationship may turn out to be great as well, not necessarily abusive.

        • +2

          I do love the first question. Kind of a nature vs nurture with little genetics. I debate this with myself quite regularly!

          • +5

            @Soluble: This so-called psychiatrist dodged the actual question.

            • @brendanq: Agreed, I was quite disappointed with that non-answer. I'll take my question to a philosophy forum.

              • @Scrooge McDuck: How about this article?
                https://www.researchgate.net/publication/276922271_Meta-anal...
                You could potentially, in a proportional way, blame your environment or genetics for compelling certain things. Such as whether you are more likely to adopt smoking or drinking habits, or you are really fat because of genetics or it was just environment where you make certain choices. The thing I was most surprised about was anxiety and depression being largely environmental. Even being addicted to alcohol had a higher genetic component to it.

                • @munro999: Mark Fisher talked about this - he was of the opinion that depression was a rational response to modern society.

          • @Soluble: Nature vs. nurture is outdated, rigid and naive. It has largely been dismissed in the social sciences. The idea that behaviour can be attributed to one OR the other is very black and white.

            (I have a PhD in psychology).

        • +1

          What else is there, beyond genetics and environment?

          • @Autonomic: That's a similar question to my first one, just from a different angle. The free will of the individual could be one. If that can't be distinguished then our justice systems are sorely mistaken. In that case, the guilt of an offender with a named and diagnosed mental illness is not qualitatively different from one without; since what would be conventionally regarded as malice/deviance/immorality/etc of the latter, would also arise from genetics and environment.

            However, if certain named mental illnesses are known to have better treatment and rehabilitation prospects, that would be a material difference which should be considered during sentencing.

            • +1

              @Scrooge McDuck: You're assuming that the objective of our justice system is to assign some purist version of "moral" blame to the wrongdoers. To the extent that it does so, that aim is largely secondary - it is important for its legitimacy in the eyes of the wider public for the law to accord with norms of abstract justice, but not essential to its function. The function of the justice system is to ensure societal stability and cohesion.

              The law must imprison the schizophrenic murderer because it is necessary, and not because it is "good" (although the wider perception that it is good, as I note above, is important). The distinction between the person who is sent to jail and the person who is sent to The Park (for people based in Qld) is not a distinction between who can "choose" and who can't. It is a distinction between those for whom deterrence is a useful strategy and those for whom it is not.

              People are not "prisoners" of their genes and environment. They are their genes and environment. The justice system, much like everything else, is an environmental stimulus. When I use a crop upon a horse I am not making a moral judgment. I am modifying the horse's environment to make it do what I want it to do. Of course there are horses that cannot and will not change no matter how hard you whip them. They get sent to the Park.

              To paraphrase Nietzsche: "that there is no good and no evil does not mean that there is no good and no bad".

            • @Scrooge McDuck: Personally I don't believe free will exists. Every choice we make is either guided by some genetic predisposition or the environment we grew up in.

            • @Scrooge McDuck: With the obvious exception of actual psychosis, why would a mental illness (formally diagnosed or not) excuse criminal behavior?

              I mean they are knowingly acting with criminal intent regardless of mental predisposition.

              • @trapper: It doesn't. Being sufficiently ill to avoid criminal responsibility is actually quite a high bar to clear. The jails are full of people with psychotic disorders.

  • +3

    Who is the best? Frasier Crane, Ben Sobel, or Dr Phil

    • +24

      They all are as equally incompentent as Harley Quinn in Suicide Squad

      • +2

        Yeah but none of them are as good looking…

      • Not in Birds of Prey?

        Just kidding I couldn't finish that movie….

  • -3

    How many shrinks would it take to change a Trump?

    • +1

      How many Trumps would it take to change a shrink?

    • +3

      Wait till 21 January 2021

  • +1

    Why am I sad

    • +44

      I, too, would be sad if I forgot my socks.

      • +3

        Have you seen them? I'm so lonely without them.

    • +2

      Ethan has already found the reason

  • +1

    What’s the total Uni fee/debt like

    • Like a lot…..
      Depending upon the university you choose it may be anywhere from 30,000 to 70,000$/year for the four years course

      • 4 years to be a psychiatrist??

        • +1

          4 years of med school post-graduate yeah?

          • +5

            @sakurashu: 4_6 years of medical school to become a doctor first and then five years to become a psychiatrist.

            • +2

              @DiLs: Respect.

              I can't imagine myself attending uni again. done. done. done.

              genuine question : Were you making any money after 4 years of med study or just studying the whole time?

            • @DiLs: And some people from above said Psychiatrist has less "knowledge" than a General Medical Doctor.

  • How do you find a good shrink, I'm currently looking for one.
    Is their a website you would suggest to find one or is it just typically word of mouth?

    Should I also speak with a shrink for a initial general consult and then go from there?
    As specialists for the suspected diagnosis have wait times between 9 - 12 months.
    Have spoken with my GP and a psychologist who have differing opinions on the suspected diagnosis.

    • +1

      It's generally word of mouth. Some people may also consider online reviews like Google. Your gp may also be able to guide about good psychiatrists close by. You can also use the find a psychiatrist option on RANZCP website. Best wishes.

    • +1

      It is advisable to speak to a psychiatrist for initial consult and they may be able to direct you to the right professional. They may also be able to help you in the meantime until you get seen by the specialist of suspected diagnoses.

      • Thank you for taking the time to answer my question!
        I had already been taking a look at the RANZCP site, so its good to know I was on the right track.

    • The GP can generate a mental health plan that will give you 10 free sessions at a psychologist per calendar year (with covid it's increased to 20 for the current time). I would go down this path and get a formal diagnosis in writing from the psychologist while searching out a psychiatrist. The psychiatrist based on what I have seen will only be able to help if they can find some imbalance with chemicals in the brain that can be fixed/resolved with medication.

  • +2

    Lol where did OP go, started an AMA and is MIA!

    • +6

      OP is making us crazy so we all go see him/her.

      • Did I succeed?

  • Do you see more patients during this pandemic?

    • +3

      Yes, especially anxiety is on the rise. Similarly some depression from lockdown and financial stressors. Some people may have exacerbation of OCD.

  • +6

    What are your thoughts on the following?

    1. New diagnosis of things typically diagnosed in childhood in adulthood e.g. ADHD, ASD? Helpful or harmful? Do you see people improve functionally with these diagnoses and targeted approaches for these in adulthood

    2. Psychedelic therapy e.g. With ayahuasca, psilocybin, LSD etc. Is there any of this happening in Australia? Do you think it could benefit many people?

    3. Psychodynamic approach. Does it have a place in modern psychiatry? Do you drawn on it in your work?

    • +4

      Very good question. They are some very interesting and controversial topics.
      1. There is indeed a lot of debate in medical circle about 'over-diagnosis' but people with ASD, ADHD do certainly improve in functioning and behavior with treatment.
      2. There is limited but emerging evidence that psychedelic therapies may have therapeutic benefits in the treatment of a range of mental illnesses.
      • Psychedelic substances are illicit substances and cannot be prescribed or administered outside of properly approved research trials.
      • Current research confirms the presence of psychological support as an essential component of the psychedelic treatment model. This requires trials to be carefully designed and led by researchers with appropriate psychiatric and psychotherapy training.
      • Further research is required to assess the efficacy, safety and effectiveness of psychedelic therapies to inform future potential use in psychiatric practice.
      • Research into the clinical use of psychedelic substances should only occur under research trial conditions that include oversight by an institutional research ethics committee and careful monitoring and reporting of efficacy and safety outcomes.
      3. There is indeed evidence of efficacy of psychodynamic psychotherapy but it is becoming increasingly difficult due to the time involved and thus some shorter versions of psychodynamic psychotherapy have been introduced. I do not generally utilize in practice.

      • Thanks

      • +1

        I believe they are trialing the use of psilocybin for patients on palliative care in a hospital in Victoria.

        • +1

          Oh that’s really interesting, and makes sense as a potential cohort that could benefit.

      • Its not something you have studied it would be specialised field to know about physchedlics. The answers given seem like a googled response, so its safe to say anyones opinion is just as good as yours on this topic right?

    • +4

      If it interests you I am 24 and was diagnosed with ADHD in August. Being diagnosed and getting treatment has been one of the best things to happen to me in my life. A few of the more noticeable changes have been;

      1. Improved memory (I used to be hopeless and remembering things, even small lists)
      2. I started fidgeting less.
      3. I don't speak so loudly in inappropriate settings.
      4. I interrupt people much less (also involves less talking overall).
      5. My impulse control has skyrocketed.
      6. I have become hugely more productive at work. (previously I got distracted or started daydreaming very frequently, in hindsight I am talking as much as every few minutes)
      7. I stopped making basic mistakes on a regular basis (mistakes at work I shouldn't be making)

      There are other things but those are a few of the big ones off the top of my head.

      • +3

        Great effort!
        Solder on your path of treatments and don't give up.

  • My sincere apologies for the delay in response.

    • +1

      What is the worst mistake you have made at work?

      What is the worst choice that didn't have negative consequences you have made?

      What do these questions tell you about me?

      • +8

        Honestly I have tried to think about it previously as well but thankfully I could not find anything grave enough to be called 'worst'. There were some small things etc but nothing big. These questions tell me that you are slippery.

        • +2

          Your response tells me you have humor and you reach for easy answers :)

          I'm glad you have no major regrets

        • Say you have had a patient and they used your advice and it exacerbated their problems down the line after no longer continuing your sessions. We cant really know the answer to this

  • +1

    Thats interesting, would you care to tell me more…..

    • How much time you have?

      • +2

        Only 5 more minutes until my 3 hour break. But we can schedule another appointment 6 months from now.