Psychiatry, psychiatrists and your mental health

In the alphabet soup of providers of psychotherapy and mental health care, psychiatrists have the most stature and, consequently, the greatest influence on the practice of mental health care and what defines mental illness. Before we elaborate, allow us to make clear just who a psychiatrist is:

Psychiatrists are medical doctors. This means they have completed medical school, a residency in psychiatry, and (in the United States) are board-certified and licensed to practice psychiatry. This practice includes psychotherapy as well as the diagnosis of mental illness, the prescribing of psychotropic medications (those medications used in the treatment of mental disturbances ranging from depression to schizophrenia) along with a handful of other medical procedures.

There is much overlap with other professionals in regards to what psychiatrists are allowed to do. Many professionals can make mental health diagnoses and practice psychotherapy. Psychiatric nurse practitioners (and in some states, psychologists) can prescribe some psychotropic medications and, in fact, most psychotropic medications are prescribed by primary care doctors.

All of that said, psychiatrists are generally considered the authority on all of these matters. It is the American Psychiatric Association, for example, that published the (THE) manual of mental disorders, the DSM-V, which names and defines the diagnostic criteria for all mental health diagnoses.

What does any of this matter?

For one, it's important to know that psychotherapy as a disciple emerged from the practice of medicine, and consequently hangs on assumptions related to the medical model: the physician (or other provider) makes a careful assessment, discerns the "correct" diagnosis, and administers that treatment which research best suggests will help the individual with that particular diagnosis. While you might see that as self-evident, there are many ways of helping you with your emotional problems that are not dependent on this diagnostic, medical model. While this is how most psychiatrists and most psychotherapists practice, there are many therapists who do not subscribe to this assumption, and many patients who are seeking less stigmatized, more creative approaches to overcoming emotional difficulties and creating their lives.

It's worth noting that there is a modest anti-psychiatry movement that heavily criticizes the medical-model approach to understanding and diagnosing mental illness. While we think many of the concerns raised by this movement are meaningful, we also recognize a significant value in psychiatry. We have the privilege of working with many skilled psychiatrists here in New York City and elsewhere who view the medical model as merely one part of an overall approach to helping those who are in distress.