What are "real" doctors' views of psychiatry?

Last week there was a meeting of about a dozen doctors in the office of the hospital where I work. It’s a cancer research center, and these doctors were all pathologists and cytologists specializing in cancer. Someone at the party brought up psychiatry, and said basically that they are quacks and that it is an inexact science. He also said that it takes resources away from people who need it more (ostensibly the cancer patients).

This hasn’t been the only time doctors have expressed such views in the office. A few weeks ago, one of the doctors who actually works in the office complained because we have to fill out this new type of form for psychological harm caused by incorrect test results. She also said it was inexact, and that “if these damn psychies didn’t complain we wouldn’t have to do this.” Typical office bitching? Or an expression of a commonly held view?

Are these views typical of doctors, especially those who work with serious diseases such as cancer or heart disease? Bonus points for people who answer this who are actually doctors.

Medical truths from a medical student perspective:

Everyone thinks that their own specialty is vastly underfunded and that it is the most important one of all. This goes for everyone from Pathologists to heart surgeons, Gynaecologists to Radiologists, family doctors to Psychiatrists. The seriousness of the conditions they deal with has nothing to do with it.

Many doctors remember their student psychiatry rotation as 4 weeks of being screamed at by floridly psychotic people, while sitting in a locked ward they couldn’t get out of for at least 8 hours.

They also remember that whatever happened, the patients didn’t seem to get better, and that the drugs had horrible side effects. Plus, many of the patients were fairly unpleasant people, who sometimes didn’t want to get better.

The general feeling amongst surgeons and physicians that I know is “rather them than me”. They admire psychiatrists for doing a job they wouldn’t do themselves, but think that there must be something slightly wrong with them for wanting to do the job in the first place.

By “slightly wrong with them”, I mean that most doctors like dealing in absolutes, and things they can see, feel, cut out and most importantly FIX. People who deal in feelings, thoughts, ideas, and who are happy if their patient feels a little better today than they did yesterday, often don’t sit well with this type of person. If it’s not hard science, they don’t like it - they may see it as “touchy-feely, waffly bullshit” if you prefer.

On the whole, however, most doctors are glad of psychiatric services, they just wish they worked better and helped the patients more than they do. They also want this to happen in a way that doesn’t take funding away from their own specialty.

Very few doctors would have a problem calling in psych services if they thought the patient needed it, they just might not be convinced it will do any good.

Little bit of bitching, little bit of typical mindset.


Psychiatry is certainly made up of enought hard science to qualify as medical science. Psychiatric illness are medically indicated and presently the treatments are, very largely, drug based.

Moreover, psy-illnesses can be disabling and cause death.

The 4 psychiatrists I know are the equal in respect of any medical professional I could care to name and I’ve never heard psychiatry disparaged by anyone in the medical profession.

I certainly believe that most of the “talking cure” basis of psychiatry is bullshit and am happy to concede that the shoddiest doctors I have encountered, as a group are psychiatrists, however they are REAL doctors. Psychiatry is a group of post graduate specialty trainings available in a range of fields.

Psychiatry isn’t seen as science by a lot of people and very rightfully so.
Psychiatry doesn’t have any solutions to problems accept medicating anything and everything.
I think in most cases Psychiatry does more harm than good. (Just my 2 cents, though).

I must respectfully disagree. A doctor would prescribe medicine for a heart patient, or a woman recovering from breast cancer, or someone who has high cholesterol. What’s wrong with prescribing medicine to even out abnormal brain chemical levels?

a) Bringing up the fallacies of “talking therapy” (usually with Freudian couches in mind) to bolster the scientific basis for medical-model psychiatry is a lot like using the silly claims of Scientology to argue in favor of faith-based healing. It’s a straw-man argument. Very very few of the folks who are critical of the modern practice of psychiatry are even remotely pro-Freudian.

b) I’ve said this before, so if you’ve encountered this, feel free to skip down: Once upon a time, round about the time Louis Pasteur’s discoveries were new and exciting, there was a lot of optimism that the peculiar ailments of the mind formerly thought due to ill spirits and whatnot would yield up their secrets to scientific inquiry and turn out to have causes similar to other diseases, and cures would be forthcoming. At this time, mental bins were largely modeled after those set up by Kraepelin and Bleuer, and did have doctors in charge of them although the “treatments” were coercive behavior-management models such as the so-called “moral treatment”. Anyway, to a major extent, the optimists were right: one widespread dementia pattern turned out to be caused by syphilis infection in its latter stages; a small handful turned out to be different manifestations of epilepsy; another common became understood as hypothyroidism; and so forth. But what happened was, once a true medical explanation was found for this or that “madness”, the treatment of that condition was lifted out of the awful grey domain of the mental sanitorium and taken over by doctors who actually practiced medicine: internal medicine handled syphilis, endocrinology laid claim to thyroid diseases, and neurology took over epilepsy and seizure disorders. This was in part necessary because people suffering from diseases that could actually be effectively treated and cured were not to be relegated to the company of folks for whom there wasn’t much real hope, and the keepers of the human warehouses in which they were held. Meanwhile, parallel to these success stories, the myth of appropriate medical treatment for mental patients in general flourished as window-dressing for institutionalizing nuts and keeping them locked up. Society’s conscience was salved by the notion that the people held in such places were getting the best treatment available for such unfortunates. For every generation since Pinel struck the chains from the psychotics in the Biticre in the late 1700s, the story has been “Oh, simply awful things were done to the poor mental patients a couple generations ago, barbarian places those insane asylums, snake pits I tell you! But it’s all better now, scientific, you know, compassionate and medicallly-based and they know what causes these problems and what to do about them, and the folks who are in there get the best of treatment”.

c) Psychiatry today is well-stocked with idealistic medically-trained personnel who are trying to do well by their clients. They are, as a general rule, very very heavily lobbied by the pharmaceutical industry from the time they apply to medical school through last week, to think of mental illness treatment in terms of “use this new miracle pharaceutical”. Despite that, many of the doctors practicing psychiatry are well aware that the search for a true etiological explanation for the mental illnesses, and for treatment that renders cures rather than simply making symptoms easier to manage, is a search as of yet unfulfilled. They use the tools available to them to lessen suffering as best they know how, and they have no incentive for standing on the rooftop shouting “We’re doing what we can but we don’t really know what the fuck we’re doing!”

d) There have been recurrent waves of oppositional thinking that have dismissed the medical model of psychiatry. With psychiatry perpetually making claims to etiological and curative knowledge that it simply can’t back up, there have quite often been people who have said “This isn’t a medical problem, give it up and rethink it”. The constellations of thinking, feeling, and behaving have been recast as social-psychological in origin, or political-social-psychological, or as non-pathological normal processes of growth and development, or as the mind’s healthy method of working through pathological psychological problems, or even as biological predispositions that only manifest as those symptomatic behaviors and etc under certain stress conditions but which are best treated by reducing the stress conditions.

e) What may be the most important shift in the last 35 years is the slow rise of self-determination among folks with psychiatric diagnoses. The opinions of the patients themselves regarding what the problem is and what to do about it runs the gamut — there is a Mental Health Consumer Movement largely comprised of people who believe in the medical model and wish to have access to the modern pharmaceuticals, but who want the same right to refuse unwanted medical treatment as any other medical patient, and who want to see psychiatrtic treatment and practice subjected to the same accountability and oversight as other branches of medicine. They’re tired of being the stigmatized patients of a “ghettoized” profession. And they want equitable insurance coverage for the treatments they need, and protections against discrimination against people with psych diagnoses, etc. Then there is a Mental Patients’ Liberation Movement which is generally opposed to the medical model (::raises hand to identify self::slight_smile: and whose members put faith in user-run self-help treatment modalities that don’t involve medication. These folks are even more vehemently opposed to forced treatment because not only do they insist on self-determination, they also believe most medical-model psychiatric treatment is dangerous rather than helpful. Many of them do not consider themselves to have any problem aside from the social problem of not being left alone by folks trying to impose unwanted psychiatric treatment on them. At any rate, what the two components of the mental patient self-determination movement have in common is the attitude that we should be allowed to choose for ourselves.

There is an undercurrent of belief within the other branches of medicine, even among doctors who believe that the mental illnesses do indeed have a biological component, that psychiatric medicine’s claims to medical professionalism are somewhere on a continuum between “best taken with a few grains of salt” and “absolute quackery touted by snake oil salesmen”. The history of psychiatry feeds into this, as does the presence of involuntary treatment.

Psychiatrists ARE “real doctors.” That’s what differs psychiatrists from psychologists-psychiatrists have an MD.

As someone whose life was pretty much saved by psychiatry, I take issue with the idea that it’s all just quackery.

Well, they were talking about psychiatrists; that’s what I assume was meant by resources, the medications and hospital beds that could just as easily go to cancer patients. Cancer docs and therapists aren’t in direct competition with each other, but in a sense I guess you could say c-docs and p-docs are.

Bumping this in the hopes that some more doctors/med students will answer. This might possibly work itself into a book, so I’d like a varied set of opinions.

Well, psychiatrists are “real doctors” in that they have graduated from real medical schools.

Perhaps the OP’s question could be better phrased, “What do neurologists and serious students of the brain think of people like Sigmund Freud?”

In that case, I can tell you that serious modern neurologists LAUGH at Freud and his disciples. Increasingly, serious doctors believe that all our thoughts and feelings are a matter of brain physiology and brain chemistry, and scoff at the notion of lying on a couch and talking about problems as a serious cure for genuine mental disease.

Because the efficacy rates are so poor.

Many Fail to Recover with Depression Treatment

Ah…but there have been studies which show that results from anti-depressants and cognitive behavioural therapy (CBT) are similar.

Another study showed that CBT shows the same changes on a depressed patient’s brain scan as a course of anti-depressants.

Psychiatry is objective, if the patient looks better, feels better and sounds better than they ARE better.

Which is easy if better means “the TV isn’t talking to me anymore” and more difficult if better means “I’m a little less unhappy today than I was yesterday”.

Very few psychiatrist believe in Jungian or Freudian things anymore, CBT is basically where it’s at nowadays. It’s problem-based, step-by-step, practical, goal-orientated etc.

All doctors in all specialties are exposed to psych patients. Oncologists will deal with abnormal grief reactions, anxiety and depression on a daily basis, for example. If you go and look at these “sceptical” cancer docs, you’ll find that they’ll prescribe anti-depressants, tranquilisers and sleeping tablets for their own patients quite happily, but grumble about psychiatrists doing the same for their patients.

Yes, there may still be a mental disconnect between “their” deserving, not crazy, cancer patients with depression who “just need a little help to get through a rough patch”, and those crazy psych patients who need to “pull themselves together and get over it”.

Nobody is perfect, some people take their personal prejudices into their careers, and some people just don’t have much time for people with mental illness and those who attempt to take care of them.

I’ve never had cancer, nor has anyone in my family, at least, not as far as I know. I do suffer from clinical depression exacerbated by some fairly abusive situations growing up. If I hadn’t been treated for depression, I would be dead by now. Granted that might have freed up a bed for a cancer patient, but it’s not like I’ve used one so far and, frankly, I’d prefer to stick around.

The treatment of mental illness is an inexact science, and there is a lot of progress to be made. The same drug which did wonders for a friend of mine left me jittery and nightmare ridden. On the other hand, the same penicillin which works wonders for me can, if memory serves, kill someone else. There is still a stigma attached to mental illness and it’s a terrifying thing to go through for both the peeople who have it and those who love them. On the other hand, I suspect epilepsy’s no picnic, either, even with the treatment options available today.

I don’t know why I’m more prone to depression than others, even factoring out external factors. I can’t say how much of my reaction is due to the way I was brought up and how much is biological. I do know that with good Cognitive-Behavioural Therapy a few years ago and other treatment a decade ago, I’m a lot less prone to consider myself a worthless sack of protoplasm who doesn’t deserve to live than I used to be. I’ve learned to look at my reactions to a situation and the standards I’d apply to myself and realize how unrealistic they are.

I tried to cure myself of low self-esteem and clinical depression. I was raised to consider psychiatry quackery and to assume therapy could do nothing for me. Those attempts landed me in a mental hospital, nearly catatonic and unable to deal with anything. I’m an incredibly strong-willed, stubborn person, as those who know me can tell you. The thing is, I could no more will my mind to heal itself than I could a knee injury I suffered earlier this year, or, for that matter, than I could cure myself of cancer. Believe me, if I could have, I would have.

Cancer treatments don’t always work either; a former friend of mine who suffered from a stroke will never fully recover; nor will a cousin whose heart stopped for several minutes when she was 27. No one’s saying, however, that we should stop researching cures for cancer, stroke, or heart disease or calling those fields quackery. As I said, research into cures for mental illness has a long way to go, but I’d prefer we continue with the journey. You see, while I was typing this, I put in a phone call to a man I love dearly. He knows about my condition, even though he doesn’t fully understand it. We’d both prefer I continue to enjoy his company for many years to come and that something be done about this disease so that others don’t have to go through it.


No, because I wasn’t talking about cancer doctors vs. Freudian therapists. Or any therapists at all. Cancer doctors vs. psychiatrists. That’s the topic.

That would seem to be countered by the second doctor’s grumbling about treating the psychological health of actual cancer patients. I sometimes get the feeling that doctors see patients as machines that need to be repaired, and that as long as their trial-and-error tinkering doesn’t result in death, it’s no big deal. You had to wait six months for a diagnosis? Too bad, you should be grateful you have one. You had to have an unnecessary surgery? Well, so what, it’s not like it caused any real damage. (Maybe this should go in that Pit thread about doctors?)

I would like to thank you for being the only med-type person to answer my question. Not to discount anyone else’s answers, but I am especially interested in what DOCTORS (both “real” and psych) have to say.

Hmm…or maybe the doc who objects to the form is of the “sweep it under the carpet, what they don’t know won’t hurt them” school. They definitely still exist.

I don’t know, my mother works in oncology and her two main gripes with oncologists are about doctors not being able to let their patients go (i.e. intensive chemo when a bed in a hospice would be in the patient’s best interest) and about them not being able to tell them the truth (telling the aforementioned chemo patient that they are “confident” it will work, when everyone knows it won’t).

Every branch of medicine attracts it’s own special type of people. The paediatricians are incredibly driven, diplomatic people who can face seeing children dying every day and yet carry on as normal.

The orthopaedic surgeons have a reputation as being big, strong and not too bright. They see people in terms of levers and pulleys, and don’t really get “holisitic” medicine.

Surgeons in general are hard-core, and prefer their patients unconscious and uncomplaining. They find dealing with real people makes it too difficult to cut them open.

Psychiatrists are supposed to be slightly eccentric themselves, to deal with weird patients no-one else wants, and to have the worst tools imaginable in order to do this.

I could go on, but I won’t. It’s all stereotypes anyway, with little grounds in truth or reality, but it might help to explain how people think. Just because stereotypes aren’t true, doesn’t mean that people dont use them as shortcuts to thinking.

Do they play the TV show House in Ireland? This reply really reminded me of it. Except he never seems to have much trouble cutting them open even after they complain.

I guess I’m just so curious about this question because it’s something my mom always told me about my dad, that he was wrong for spending their money (which was largely her money) on mental health care and saying that if he only knew what real suffering was he wouldn’t have to run to those quacks. Even if not all doctors think this way, the fact that a couple of them do makes all the difference to me. I guess I always kind of knew she was right, but this cements it.

If a few doctors think a certain way, your mom was right? Huh?

First, your mom had no business saying anything of this sort to you, the daughter. Good parents don’t bash each other to the children.

Second, I have worked with tons of patients (I am a psychologist) who have said that the mental anguish they suffer is tons worse than the physical anguish. This included a patient with a very severe pain syndrome (complex regional pain syndrome) who said that her depression was more painful and affected her quality of life more. Since I said it, does that make your mother wrong?

If it wasn’t clear already, I meant to imply that the doctors who think that way are old-fashioned dinosaurs, shaped by bad experiences and personal prejudice!

There is a survey somewhere asking people to rank their experiences of labour pains, kidney stones, broken limbs and severe depression. Depression comes out top as the experience people never want to go through again.

Just because the drugs and therapies for mental illness aren’t perfect, doesn’t mean that they don’t make life liveable for many, many people. People can’t just “snap out” of these things, they need help.

Death is a very real complication of mental illness, either through suicide, substance abuse or poor impulse control and bad risk-taking. People need and deserve help with their mental illness just as much, and sometimes more than, people need and deserve help with their physical illness.

Just because I, personally, wouldn’t go into psychiatry as a career, doesn’t mean that psychiatrists don’t do a worthwhile and valuable job.

I couldn’t agree more. I just think it is sad that 50% of the people who spend years in therapy and thousands of dollars on prescriptions are going to be disappointed. As if they didn’t have enough on their shoulders.

It is sad, and I wish the cure rate were higher (although the study you have cited is the lowest I have seen). On the other hand, do you have a better idea? I get the feeling you are advocating against therapy and medications, but what would propose instead?