What comes to mind when you think of a psychiatrist? A patient lying on a long leather couch? An imposing-looking doctor in a lab coat, scratching away at a notepad?
Pop culture rarely portrays psychiatry in a flattering light. Terms like “shrink” make psychiatrists seem scary and the treatment process negative. Movies and TV shows have conditioned us to feel that only “crazy” people go to “shrinks,” and that if you have to see one, there’s something seriously wrong with you.
Like many aspects of movies, this isn’t reality. The American Psychiatric Association defines psychiatry is an important “branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioral disorders” and should be feared no more than other medical disciplines. Would you be ashamed to go to your doctor to treat a broken leg? No, and neither should you be ashamed to see a psychiatrist.
Still, like any other new experience, your first appointment with a psychiatrist can feel intimidating, especially if you don’t know what to expect.
So, let’s take a look.
What Does a Psychiatrist Do?
There are many types of mental-health professionals: psychologists, psychoanalysts, social workers, counselors, and several types of therapists. Whereas most therapists’ scope of practice is limited to psychological treatments such as cognitive behavioral therapy, psychiatrists are medically trained and can offer pharmacological treatment as well as psychological.
“So the advantage of seeing a psychiatrist is that you have someone who’s looking at your brain both from the biology…as the psychological aspect…which you’re not getting if you see a therapist,” said Dr. Eric Rafla-Yuan, Department of Psychiatry Chief Resident Physician at the University of California San Diego.
Additionally, “psychiatrist” is a protected term. Not just anyone can call him or herself a psychiatrist, whereas “therapist” is a slightly looser term that can include many professions, and can include different training or certification.
When Should You See a Psychiatrist?
Imagine you have a cold. Your throat is sore and you cough all night. That’s not so bad for a few days, right? Now, imagine it’s four weeks later and you’re still hacking up a lung — it’s probably time to see a doctor.
The same protocol should be applied when it comes to the mind. “You should consider seeing a psychiatrist if you are concerned about symptoms impacting your day-to-day life,” said Dr. George Hadeed, a Tucson, Arizona psychiatrist and Clinical Assistant Professor of Psychiatry at the University of Arizona College of Medicine.
Maybe you’re struggling to complete your work or school assignments, having trouble eating or sleeping, or perhaps you’re isolating yourself from friends and family. You might also find yourself “doing things without understanding why,” said Dr. Gerald Shiener, Chief of Psychiatry at DMC Sinai-Grace Hospital. If you find yourself struggling with these daily tasks, consider seeking professional help.
It’s possible you might be seeing or hearing things that aren’t there. If you’re feeling like harming yourself or that the world would be better off without you, you should seek help immediately. Immediate help can be found using National Suicide Prevention Lifeline, by calling 1-800-273-8255 — it’s available 24/7.
If You Go to a Psychiatrist, is There Something Wrong with You ?
Unfortunately, because of the stigma that surrounds it, many people go without much-needed treatment. Many fear of being labeled, and there are many pejoratives for people who struggle with their mental health, words like “crazy” or “insane.”
“A good psychiatrist will acknowledge these fears, empathize with the patient, and assure them that they are not ‘crazy,’” Dr. Hadeed said.
Another common fear is of how psychiatric medication might affect one’s thoughts or personality. People worry a psychiatrist will push a bunch of pills at them, that there will be side effects from medication, or lose their ability to concentrate or perform certain tasks.
Dr. Rafla-Yuan pointed out that although psychiatrists have the authority to prescribe medication, it doesn’t mean they have to. Many psychiatrists combine pharmacological treatment with therapy or even “prescribe” therapy alone.
“The goal of the psychiatrist is to help their patients, and if they think they’ll benefit from medication they’ll bring that up as an option,” he said. “But I have lots of patients where I don’t think that medication is going to work well for them or is going to solve the issues they’re having.”
Even if you do come home with a prescription, it doesn’t mean it’s set in stone. If you experience negative or unwanted symptoms, your psychiatrist will work with you to adjust your treatment plan and try something different.
What Happens in the First Appointment?
The first appointment is all about getting to know you. In order to prescribe the best treatment plan, your psychiatrist needs to know as much as possible about your medical and psychological history.
You should come to your appointment with a list of current and past medications, lab work, and hospitalization records, if applicable. If you don’t have or remember those things, provide the contact information for your primary-care doctor or previous mental-health practitioner, and your psychiatrist can obtain records from him or her. Your psychiatrist will also ask if you’ve tried any therapies in the past as well as inquire about your family’s medical history.
In addition to your medical history, your psychiatrist will need to ask you some personal questions. While this can feel uncomfortable at first, remember that this is a confidential setting and the information you share is protected under federal law (unless there is a serious risk of harm to yourself or others).
“I tend to break it up into three sections,” Dr. Rafla-Yuan said. Section No. 1: “How are you doing right now?” “What prompted you to come in today?” “What’s it like where you live, and what are your relationships with the people around you like?”
Section No. 2: “Where did you grow up?” “What was school like for you?” “What did you do after school?”
Then, Dr. Rafla-Yuan does what he calls a “trauma history screen,” asking if there were times when the patient felt overwhelmed or unsafe.
If there are concerns about possible contributing factors such as medical conditions, your psychiatrist may order laboratory testing to help rule out medical causes for your symptoms. Some medications may require specific laboratory testing to be done prior to starting the medication. Others do not require laboratory testing. Your psychiatrist may decide to start you on a medication after your first visit, or may want you to come for another appointment to further discuss treatment options.
As the end of the appointment rolls around, you will both discuss a treatment plan and next steps. It’s likely it will include medication, talk therapy, or both.
“The treatment plan often depends on how severe the symptoms are,” Dr. Rafla-Yuan said. Mild symptoms could be alleviated with nonpharmacologic strategies. For patients with moderate to severe symptoms, he’ll often recommend a dual approach.
“A huge number of studies show that therapy works and medications work, but both of them together is better than either of them alone,” he said.
What Comes Next?
Broken legs heal in six to eight weeks. But what about minds? It depends on the person, Dr. Rafla-Yuan continued.
Some patients who begin therapy or a medication do so after experiencing an isolated incident of stress or trauma, and may begin to feel better after several months of treatment. “They slowly taper off [treatment] and when they get all the way off it they’re kind of back to where they were before all that stuff happened, and maybe they’ll never have to see a psychiatrist again,” he said.
Other patients might experience more enduring symptoms. Patients with major depressive disorder, for example, might experience an episode of major depression once every few years. “And so depending on how impairing that is, some people do better just being on antidepressants to reduce the number of depressive episodes and the intensity of how severe the depression is,” Dr. Rafla-Yuan said.
Don’t Suffer in Silence
If you’re considering seeing a psychiatrist but feel nervous before your first appointment, remember: it’s pop culture’s job to entertain; it’s your psychiatrist’s job to help you feel better. “The brain is just another organ in the body, just like the heart or the lungs, and sometimes it doesn’t do so well and could benefit from treatment,” Dr. Rafla-Yuan said. There’s no shame in seeking help.
“Many patients delay psychiatric treatment,” said Dr. Hadeed. “Don’t suffer in silence. Make that call and schedule an appointment.”