The Problem and Goal of Psychiatry

by ih-mmd ih-mmd

Unlike neurology, psychiatry deals with the issues of the mind.  In psychiatry, the symptoms that are being treated often have no visible neurological basis.  The entire psychiatric field is based on diagnosing problems by eliminating alternative explanations. That means that the psychiatrist, along with the rest of your medical team, must rule out a host of other conditions before naming a disorder. 

In neurology, the use of brain scanning (CT scan, MRI, PET scan) and EEGs can sometimes be helpful in visualizing a biological problem.  The brain is organized in such a way that a problem in a particular region of the brain would be responsible for generating a specific sign and symptom somewhere else in the body. 

Specific mental illnesses generally follow particular presentation patterns in the body.  These presentation patterns often make brain imaging unnecessary in diagnosing conditions.  Only if you present atypical signs and symptoms should it become necessary to pursue brain imaging and other biological tests?  For these reasons, during a psychiatric evaluation, you should tell your psychiatrist or psychiatric nurse practitioner not only the mental symptoms but also the bodily symptoms (and anything else you can think of, including the signs your loved ones have been noticing).  This approach is more likely to yield you a more accurate diagnosis and might render brain imaging unnecessary. 

The field of psychiatry lacks the certainty that is common in other areas of medicine.  The psychiatrist is an expert in prescribing medication to treat mental illness.  Although they possess the current knowledge of how drugs work on the mind, brain science remains mostly a mystery.  A common mistake made in the field is believing because a drug was intended to treat particular disorder just because it solved the problem in a specific instance.  To add more certainty to a psychiatric diagnosis, the psychiatrist should attempt to get collateral information which will either corroborate or negate the patient’s interpretation and the psychiatrist’s initial determination. Appropriately done, psychiatry will rule out biological and toxic causes first, and then offer medication, where necessary, to reduce symptoms temporarily such that the patient is able to learn adequate coping mechanisms and sustain the highest level of function over time.  The goal is to make the medicine unnecessary after the proper coping mechanisms are adopted.