Psychologist and psychiatrist: how to make an informed choice

When it comes to emotional distress, the prevalent confusion even among educated minds is 'whom to consult - a psychologist or a psychiatrist?' The bunch of suggestions you could expect in this situation would be 'Hey, they do the same work, psychiatrists are doctors while psychologists are not, Psychiatry is really scientific but Psychology is more of grey.

Well there are truths as well as misconceptions in the above statements.

We could find an overlap in both the professions - Psychiatry and Psychology and the area of expertise is the human mind .They often work hand-in-glove to prevent, diagnose, and treat mental illness. The aim of their profession is the same - bring a distressed human being back to normal life.

The differences

That being said, do they have exactly the same job? Not at all. Are psychiatrists and psychologists the only mental health professionals you can choose from? Again, no. Though not that common in India, there are other mental health professionals like social workers, counsellors, psychiatric nurses, and nurse practitioners to choose from. Mental health system is not a single entity where you go to one person and get all help.

Where to start?

Mental health issues, especially persistent or frequently recurring ones, could be debilitating. Like the physical illness, mental conditions like depression or anxiety could also do harm to your body. In some other cases mental problems can be triggered by some physical conditions as well. At times, you could develop a condition which shows all the symptoms of mental disorder, but could be a neurological or some other physical problem. For example, some types of epilepsy, hypoxia, and certain neurological conditions like Anti-NMDA Receptor Encephalitis, certain tumour or even migraine could be mistaken for mental distress. So the simple rule is, if you think you have a problem, either physical or emotional, the first person you should consult is a physician.

Based on your symptoms, nature, the duration, the onset and frequency of the problem, the physician will go further to find the right treatment for you... The primary objective is to find the presence of any physical problems that could be causing your symptoms. After the preliminary examination and diagnosis, it is for the physician to decide whether you need to see any other specialist or mental health professional.

Types of mental health professionals:

Psychiatrist: A psychiatrist is a medical doctor with an MBBS and MD Psychiatry. He specializes in diagnosing and treating mental illness. A psychiatrist has ample training to differentiate mental health problems from some other medical conditions that co-occur with psychiatric symptoms. Some mental illnesses have an effect on physical conditions such as cardiac problems or high blood pressure. Psychiatrist also has the knowledge of the effects of medicines on the body like blood sugar, blood pressure, sleep etc.

In a mental health scenario, of all the mental health professionals, only a psychiatrist is licensed to prescribe medicines. Many mental disorders such as depression, anxiety, ADHD, or bipolar disorder may need a medical management.

Psychiatrists focus mostly on medication management. But many a time medication alone could not treat the mental illness. A combination of psychotherapy along with medication is necessary to bring back a person to normal life.

Psychologist: A psychologist is a person who has at least an MPhil in Psychology. They focus on mind and behaviour; evaluating and treating mental and emotional disorders and administering psychotherapy.

A psychologists should be qualified to conduct psychotherapy, counselling sessions, perform psychological testing, and provide treatment for mental disorders. In India, like in most other places in the world, psychologists cannot write prescriptions or perform medical procedures. Psychologist often work in association with a psychiatrist or other medical doctors.

Psychiatric social worker: A psychiatric social worker holds a master's degree in social work. They evaluate the sociological background of the patient and illness and perform initial assessment of the emotional state of the patients. In addition to counselling, social workers can provide case management, hospital discharge planning as well as work as an advocate for patients and their family. So, in a mental health scenario, a psychiatric social worker could be the first person of contact and at the same time a person coordinating the treatment plan, communicating effectively with the patients, psychiatrists, psychologists, mental health nurses and the family of the patients.

Difference between counselling and psychotherapy

Counselling and therapy are often used interchangeably. But they are not exactly the same. Counselling focuses on specific issues such as addiction, stress management, family problems etc and is designed to help a person address a particular problem. The main focus of counselling is problem solving or learning specific techniques for coping with or avoiding problem areas. Compared to psychotherapy, counselling is more short-term.

Psychotherapy focuses on a broader range of issues and is more long-term in nature. Depending on the specific type of psychotherapy that is being used, the goal is to help people feel better equipped to manage stress and understand patterns of thinking and behaviour that affect the way a person interacts with the world. Some behaviour may interfere with attaining personal goals and maintaining more satisfying relationships. So, the main goal is to regulate their thinking and emotional responses to stressful situations. In a mental illness such as depression or anxiety disorder, psychotherapy also addresses ways in which the illnesses affects their daily life, create an insight on the plight of their situation. It focuses on the management of symptoms and to instruct to follow medical recommendations.

Getting started with a mental health professional:

So, finally, if you think you or your loved one is in need of a mental health support, the first person to see is not a psychiatrist. People often complaint that the psychiatrists do not listen to them properly. Actually, a psychiatrist is trained in the medical management of the mental condition and he focuses only on the presenting complaint and specific symptoms. Before seeing a psychiatrist, it is always better to get a detailed reference and clear picture of your problem assessed by a psychologist.

In many conditions, psychotherapy would be sufficient to regain normalcy. In certain conditions where a medical management of the illness is needed, a coordinated effort of a psychiatric social worker, clinical psychologist and a psychiatrist would be the best treatment strategy.

(The author is a behavioural psychologist and a cyber psychology consultant)