The term "mental illness" actually encompasses numerous psychiatric disorders, and just like illnesses that affect other parts of the body, they can vary in severity. Many people suffering from mental illness may not look as though they are ill or that something is wrong, while others may appear to be confused, agitated, or withdrawn.
It is a myth that mental illness is a weakness or defect in character and that sufferers can get better simply by "pulling themselves up by their bootstraps." Mental illnesses are real illnesses--as real as heart disease and cancer--and they require and respond well to treatment.
The term "mental illness" is an unfortunate one because it implies a distinction between "mental" disorders and "physical" disorders. Research shows that there is much "physical" in "mental" disorders and vice-versa. For example, the brain chemistry of a person with major depression is different from that of a nondepressed person, and medication can be used (often in combination with psychotherapy) to bring the brain chemistry back to normal. Similarly, a person who is suffering from hardening of the arteries in the brain--which reduces the flow of blood and thus oxygen in the brain--may experience such "mental" symptoms as confusion and forgetfulness.
In the past 20 years especially, psychiatric research has made great strides in the precise diagnosis and successful treatment of many mental illnesses. Where once mentally ill people were warehoused in public institutions because they were disruptive or feared to be harmful to themselves or others, today most people who suffer from a mental illness--including those that can be extremely debilitating, such as schizophrenia --can be treated effectively and lead full lives.
Recognized mental illnesses are described and categorized in the book Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR). This book is compiled by the American Psychiatric Association and updated periodically. It can be purchased through the American Psychiatric Press Inc.
Some of the more commonly known psychiatric disorders are depression; manic depression (also known as bipolar disorder); anxiety disorders, including specific phobias (such as fear of heights), social phobia, panic disorder, agoraphobia, obsessive-compulsive disorder, and generalized anxiety disorder; schizophrenia and other psychotic disorders, such as delusional disorder; substance abuse and disorders related to substance abuse; delirium; dementia, including Alzheimer's disease; eating disorders, such as bulimia and anorexia; sleep disorders; attention-deficit/hyperactivity disorder; learning disorders; sexual disorders; dissociative disorders, such as multiple personality disorder; and personality disorders, such as borderline personality disorder and antisocial personality disorder.
* Marked personality change
* Inability to cope with problems and daily activities
* Strange or grandiose ideas.
* Excessive anxieties.
* Prolonged depression and apathy.
* Marked changes in eating or sleeping patterns.
* Extreme highs and lows.
* Abuse of alcohol or drugs.
* Excessive anger, hostility, or violent behavior.
A person who is thinking or talking about suicide or homicide should seek help immediately.
* The child seems overwhelmed and troubled by his or her feelings, unable to cope with them.
* The child cries a lot.
* The child frequently asks or hints for help.
* The child seems constantly preoccupied, worried, anxious, and intense. Some children develop a fear of a variety of things--rain, barking dogs, burglars, their parents' getting killed when out of sight, and so on--while other children simply wear their anxiety on their faces.
* The child has fears or phobias that are unreasonable or interfere with normal activities.
* The child can't seem to concentrate on schoolwork and other age-appropriate tasks.
* The child's school performance declines and doesn't pick up again.
* The child's teachers, school administrators, or other authority figures in the child's life ask the parent what might be troubling the child.
* The child is having difficulty mastering school work.
* Teachers suggest that the child may have a learning disability or other type of school-related problem.
* The child loses interest in playing.
* The child tries to stimulate himself or herself in various ways. Examples of this kind of behavior include excessive thumb sucking or hair pulling, rocking of the body, head banging to the point of hurting himself, and masturbating often or in public.
* The child has no friends and gets into fights with other youngsters. Teachers or others may report that "this is a very angry or disruptive kid."
* The child isolates himself or herself from other people.
* The child regularly talks about death and dying.
* The child appears to have low self-esteem and little self-confidence. Over and over the child may make such comments as: "I can't do anything right." "I'm so stupid." "I don't see why anyone would love me." "I know you [or someone else] hates me." "Nobody likes me." "I'm ugly. . . too big. . . too small. . . too fat. . . too skinny. . . too tall. . . too short, etc."
* Sleep difficulties don't appear to be resolving. They include refusing to be separated from one or both parents at bedtime, inability to sleep, sleeping too much, sleeping on the parent's or parents' bed, nightmares, and night terrors.
* The child begins to act in a provocatively sexual manner. This is more common in girls as they approach puberty and thereafter, but even much younger girls may flirt with men in sexually suggestive ways.
* The child sets fires.
Some symptoms or reactions are so serious that a pediatrician or a psychiatrist should be consulted immediately:
* The child talks about suicide. Children don't talk idly about suicide to get attention. Once they have begun to talk about it, they also may have begun to plan a way to do it.
* The child appears to be accident prone. In younger children a succession of accidents can become the equivalent of suicide attempts.
* The child mutilates himself in some way--cutting or scarring himself, pulling out his hair, or biting fingernails until nail beds bleed.
* The child mutilates or kills animals.
* The child's eating habits change to the point that his weight is affected. This can be caused by either overeating or undereating.
* The child adopts ritualistic behaviors. This is indicative of obsessive-compulsive disorder. A child may have to line up her toys in a certain way every night, for example, or get ready for bed following a routine that never varies. If she forgets one item in the routine, she must start all over again.
* The child beats up others--another child, a parent, or other adult.
* The child is using alcohol or other drugs.
* The child is sexually active or on the verge of becoming so. Again, this is rare in children 12 and under but certainly not unheard of, especially since there is great pressure on kids today to become sexually active at progressively earlier ages. When children are depressed or their self-esteem is low, they may be more vulnerable to that pressure. Also, if they are still hurting from feelings of rejection and loneliness related to the divorce, they may be searching for love and affection and have a need to prove their lovability.
A psychiatrist is a medical physician who specializes in the diagnosis, treatment, and prevention of mental illnesses, including substance abuse and addiction. Psychiatrists are uniquely qualified to assess both the mental and physical aspects of psychological disturbance. Their medical education has given them a full working knowledge of the many causes for a patient’s feelings and symptoms. Armed with this understanding, psychiatrists can make a complete, accurate diagnosis and then recommend or provide treatment.
People seek psychiatric help for many reasons. Life's usual round of trials may become overwhelming. Relationships may become troubled, or the pangs of anxiety - easily dismissed before as simple "nerves" - may grow sharper and last longer. The fresh-faced young newcomer down the hall at work may seem to threaten a secure job, and headaches may start to come literally one after the other. The emotions that arise in reaction to everyday stresses and strains may blow badly out of proportion, or may be strangely absent. Eating may become a refuge, and sleep may begin to seem either irresistible or elusive. Alcohol or drug use may get out of control.
The problems can be sudden, such as a panic attack or as frightening hallucinations, thoughts or suicide, or "voices" that whisper intrusive and incomprehensible things. Or they may be more long-term-such as a pall of gloom that never seems to lift, causing everyday life to feel distorted, out of control, not worth living.
Because they are physicians, psychiatrists can order or perform a full range of medical laboratory and psychological tests that provide a complete picture of a patient's physical and mental state. Their education and years of clinical experience equip them to understand the complex relationship between emotional and other medical illnesses, evaluate all the medical and psychological data, make a diagnosis, and develop a treatment plan.
A person wanting to become a psychiatrist must complete high school and college before entering medical school. While there is no requirement for a particular major, college students headed for medical school take required courses in the biological and physical sciences (general and organic chemistry, physics, biology, mathematics) as well as liberal arts courses. The prospective psychiatrist may also study social and psychological sciences and psychobiology. Most psychiatrists and other physicians feel that a liberal arts college education is the best preparation for medical school.
Medical students follow a standard curriculum, with only a few opportunities for choice. In addition to chemistry, biochemistry and physiology, students take courses in psychiatry, behavioral science, and neuroscience in the first two years of medical school. In the last two years, students are assigned to medical specialty "clerkships," where they study and work with physicians in at least five different medical specialties. Medical students taking a psychiatry clerkship take care of patients with mental illnesses in the hospital and in outpatient settings. They also have an opportunity to work with medical and surgical patients who may have psychiatric problems or who have difficulty coping with their illnesses. Because modern psychiatry places special emphasis on the relationship between mind and body, students pay special attention to issues of stress and physical illness, prevention and behavior change, in addition to learning to care for severely mentally ill patients. Newly graduated physicians take written examinations for a state license to practice medicine. After graduation, doctors spend the first year of residency training in a hospital taking care of patients with a wide range of medical illnesses. The psychiatrist-in-training then spends at least three additional years in a psychiatric residency learning the diagnosis and treatment of mental illnesses, gaining valuable skills in various forms of psychotherapy and in the use of psychiatric medicines and other treatments.
After completing their residency training, most psychiatrists take a voluntary examination given by the American Board of Psychiatry and Neurology, to become a "board certified" psychiatrist.
Yes. Many psychiatrists continue training beyond the initial four years. They may study child and adolescent psychiatry, geriatric psychiatry, forensic (legal) psychiatry, administrative psychiatry, alcohol and substance abuser psychiatry, emergency psychiatry, psychiatry in general medical settings (called "consultation/liaison psychiatry"), mental retardation psychiatry, community psychiatry and public health, military psychiatry and psychiatric research. Some choose additional training in psychoanalysis at special psychoanalytic institutes.
Because of a continued shortage in the field, psychiatrists have many career opportunities. They work in a variety of settings including general and psychiatric hospitals, university medical centers, community agencies, courts and prisons, nursing homes, industry, government, military settings, schools and universities, rehabilitation programs, emergency rooms, hospices, and many other places. About half the 42,000 psychiatrists in the nation maintain private practices.
The hallmark of a psychiatrist's career is diversity and flexibility. Although some psychiatrists prefer working only in one setting, others work in several areas, combining, for instance, a private practice with hospital or community mental health center work.
Practitioners set their own work and time commitments according to their personal lifestyles and needs.
Also, because mental illnesses affect all races, ethnic groups and cultures, the specialty of psychiatry offers special opportunities for members of minority groups.
Of all the mental health providers in the United States, only psychiatrists are fully licensed medical doctors. Because they are physicians, psychiatrists can order or perform a full range of medical laboratory and psychological tests that provide a complete picture of a patient's physical and mental state. Their education and years of clinical experience equip them to understand the complex relationship between emotional and other medical illness, evaluate all the medical and psychological data, make a diagnosis, and develop a treatment plan. Also, as physicians, they are the only mental health providers who can prescribe medication and order medical tests.
What are the differences between psychiatrists and other types of professionals who provide mental health care?
Only the psychiatrist is a medical doctor who can order medical tests and prescribe medication. It takes many years of education and training to become a psychiatrist. After earning a bachelor's degree, he or she must graduate from medical school and go on to complete four years of residency training in the field of psychiatry.
Other professionals who care for people with mental illness or provide mental health services undergo different types of training whose length and core emphases differ according to the field of study.
Psychologist: Most clinical psychologists have a master's or doctoral degree; on the doctoral level, the degree is usually a Ph.D. (doctor of philosophy) or Psy.D. (doctor of psychology, which is not a medical doctor). A psychologist applies psychological principles to the treatment of mental, emotional, and behavioral disorders and developmental disabilities through a broad range of psychotherapies. A psychologist is commonly trained in advanced psychology, abnormal psychology, statistics, testing theory, psychological testing, psychological theory, research methods, psychotherapeutic techniques, and psychosocial evaluation.
Licensed clinical social worker: A licensed clinical social worker (L.C.S.W.) is also trained in psychotherapy and helps individuals deal effectively with a variety of mental health and daily living problems to improve overall functioning. A social worker usually has a master's degree in social work (M.S.W.). and has studied, among others, sociology, growth and development, mental health theory and practice, human behavior/social environment, psychology, research methods.
Psychiatric nurse: A psychiatric nurse may have an associate arts, bachelor's, or master's degree in nursing. Much of the psychiatric nurse's specialty training takes place in a hospital inpatient service. Among the services the psychiatric nurse is trained to provide (at the order of a medical doctor) are various patient care services, administration of medication, and other duties commonly performed by nurses, such as immunizations and skin tests.
Psychiatrists use a wide range of treatments-including various forms of psychotherapy, medications and hospitalization-according to the needs of each patient.
Psychotherapy is a systematic treatment method in which, during regularly scheduled meetings, the psychiatrist and patient discuss troubling problems and feelings. The physician helps patients understand the basis of these problems and find solutions. Depending on the extent of the problem, treatment may take just a few sessions over one or two weeks, or many sessions over several years.
Psychiatrists use many forms of psychotherapy. These are psychotherapies that help patients change behaviors or thought patterns, psychotherapies that help patients explore the effect of past relationships and experiences on present behaviors, psychotherapies that treat troubled couples or families together, and more treatments that are tailored to help solve other problems in specific ways.
Psychoanalysis is an intensive form of individual psychotherapy which requires frequent sessions over several years. The psychiatrist, who must have additional years of training in psychoanalysis, helps the patient to recall and examine events, memories and feelings from the past, many of them long forgotten, as a means of helping the patient understand present feelings and behavior and make changes as necessary.
In the same way that your family doctor can prescribe medications to help patients with high blood pressure or thyroid problems, psychiatrists can prescribe a number of medications that are effective against mental illnesses such as depression, manic-depression, panic disorder, anxiety disorders, obsessive-compulsive disorder and schizophrenia. Psychiatrists use medications when thorough evaluation of a patient suggests that medication may correct imbalances in brain chemistry that are thought to be involved in some mental disorders. Psychiatrists usually use medications in combination with psychotherapy.
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