When Do You Need A Psychiatrist?

• Emotional health is indispensable to a sense of well-being, and sometimes we do need professional psychotherapy.

• There is a great difference between a psychotic individual and a neurotic one. The psychotic usually requires hospitalization, but the neurotic, although he may be unhappy, can go through life without losing touch with reality.

• The neurotic can frequently be aided by his family doctor as well as his family, friends, and. minister.

• You should have professional psychiatric care whenever your doctor advises it or you feel you need it.

• Going to a psychiatrist, who is also a physician, is preferable to going to a psychologist, who has no medical training.

• You have to be careful to avoid “psychoquacks” because too many untrained practitioners are free to operate in the United States.

We need more than physical health.

The tens of thousands of institutionalized mental patients stand as vivid proof that good physical health alone is not enough for the enjoyment of life. What good is a healthy body if you don’t even know whether you are in or out of this world?

Doctors have learned a great deal about preventive medicine. We know that it is just as important to treat the patient’s mind as well as his body; often we practice psychology without the patient knowing it. But most of us do not think of ourselves as professional psychologists or psychiatrists. When a patient is in need of psychotherapy, we know that he will need far more time for such treatment than most of us can afford to give him without sacrificing our other duties.

You have seen how often your sense of well-being may be seriously affected by inadequate sleep, chronic fatigue, and tensions. You know that in most cases, if you accept the advice of your doctor, you can meet and overcome emotional distress. But some people simply cannot be reached by ordinary means. Doctors are helpless, and they are helpless. One of you may some day experience such a time of trial. You exhaust every effort to help yourself, but you feel as if you are sinking bit by bit into emotional quicksand.

What to do?
The popular concept is that you should head straight for the nearest psychiatrist. But not so fast. There are some fundamental facts to be considered.

Neurotic or psychotic?

In the world of psychiatric medicine considerable and often highly technical jargon is employed to define and describe a seemingly endless variety of mental ailments. We need not be concerned with the many different terms.

Generally, however, emotional sickness can be placed under one of two categories, neurotic or psychotic.
The neurotic, broadly speaking, tends to distort greatly his real or imagined troubles. He is generally tense and apprehensive. But he usually understands all that is going on and can be “reached.” He can get along in the world but has decided limitations on his ability to enjoy life to the fullest. The neurotic can be aided greatly by intelligent and understanding friends, family, and minister.

The psychotic, on the other hand, is truly a mentally sick person. We might say his mind is diseased, although we don’t know whether the disease is caused by some hereditary factor, a chemical imbalance in his brain, a deep personality defect that began early in life, or a combination of all these factors. The psychotic is completely out of touch with reality. The familiar “Napoleon” delusion is typical of the psychotic. In most cases the only way psychotic patients can be helped is to send them to a hospital, where treatment may include drugs and shock therapy, as well as psychotherapy.

As an example, I can think of a young man from a rather wealthy family who came to see me because he was “unhappy.” He was in his twenties and thought that the source of his trouble lay in the fact that his father had prematurely pushed him into a position of great responsibility in the family corporation. The young man was married, had two children, and seemed reasonably intelligent. It was not unique that he felt distressed over a job he disliked. But it was highly unusual for him to be constantly irritable, and so tense that he could never relax. His sleep was disturbed, and he also had tremendous feelings of inadequacy, inferiority, and frustration. He talked about things that did not exist, although he sincerely believed that they did.

I advised his unbelieving parents that he needed psychiatric care. They resented the advice. Today that young man is in a mental hospital, and has been for a number of years.

In contrast, I had as a patient a beautiful woman of exceptional charm and talent, who had been a Miss America contestant. She had a great deal of intelligence, but she could not stick to any particular job. She had tried her hand at many things but failed. Consequently, she developed a deep sense of frustration and inferiority. She had become neurotic, but she was able to understand and accept the advice to obtain psychiatric treatment.

My point is that if you are completely out of touch with reality, it is not likely that you will voluntarily seek psychiatric care. In all likelihood, you will need to be committed to a hospital. If you can still understand what is going on, consider yourself lucky and, if your doctor feels you should have professional psychiatric treatment, accept his advice promptly.

Don’t try to figure out whether you are mildly or seriously neurotic. If you need the care, it won’t make much difference. But more important, if you feel you want the assistance of professional psychotherapy, then by all means get it. I am certain no intelligent person needs to be told that there is no shame these days in being a victim of emotional distress.

The problem of choice: psychologist or psychiatrist?

I am personally convinced that the need for psychoanalysis is often greatly exaggerated. It is a long, complex, and costly process. I think that just as some family doctors are criticized for not considering the patient as a “whole,” his emotional as well as physical problems, I believe that the typical psychologist is unable to consider the patient as a “whole,” his organic and functional ailments as well as emotions. The psychologist is not trained for it, and his experience, if any, with organic and functional body troubles are decidely limited.

That is why I prefer to send my patients to psychiatrists. The psychiatrist is also a physician. He is trained to observe your physical as well as mental problems. He can treat you as a “whole.”

I am also greatly concerned over the fact that there is too much quackery in non-medical psychology, that is among those who hang out shingles as “psychologists.” For one thing, in all but eight states it is possible for anyone to call himself a “psychologist” and play footsie with the human mind without having had as much as a high school education.

A recent investigation has disclosed that there are thousands of “psychoquacks” operating throughout the United States. Some are doing a thriving business with no more training in psychotherapy than a plumber. In fact, a few were found to have been former plumbers. Nearly all the “psychoquacks” had no professional qualifications, yet they were treating an unending flow of patients for almost every mental ailment imaginable. Ironically, they can sometimes do a world of good for a patient, especially one who may have needed nothing more than friendly association with a sympathetic human being. But the human mind was not meant to be tampered with by amateurs.

At this very writing there is loose in the United States a “psychologist” who, by manipulating professional jargon and even forging academic degrees, has managed to get himself on a variety of hospital staffs as a “psychologist” and has treated in his private office hundreds of men, women and children in all walks of life. Once, he even managed to get appointed to the U. S. Army’s Psychological Warfare Board, until his sordid record was uncovered and he was quietly “released.”

The case of this incredible “psychoquack” is typical, I believe, of how pseudo-psychological mumbo-jumbo can be employed to impress inexperienced people.

The man who is best equipped to help you decide whether you should go to a psychologist or psychiatrist is your family doctor. Accept his advice.

However, if you want to visit a psychologist or psychiatrist on your own, be sure to go to one who is professionally qualified. Your local health department can help you find a reputable practitioner. For further guidance, you may write to either the American Psychological Association or the American Psychiatric Association, both in Washington, D.C.

It isn’t as bad as it seems.

My objection to dashing off to the psychoanalyst’s couch without your doctor’s advice is based on considerable experience with so-called “neurotics.” Too many people think they are neurotic when they are not. The term neurotic has been kicked around so glibly in fiction and movies and scare articles that the minute someone is emotionally upset he thinks he cannot help himself without psychoanalysis.

Many of us tend to magnify all out of proportion an emotional upset. We dignify a normal, human reaction with unnecessary concern and fancy labels. The fact is that most of our emotional disturbances are self-limiting. We find that time, sometimes aided by the sympathy of our doctor or family, is more than enough to help us “cure” ourselves. There is no magic cure in psychiatry. No one psychiatrist has all the answers. As a matter of fact, there are so many different schools of thought among psychiatrists that aficionados of the psychoanalyst’s couch have trouble deciding what sort of psychiatrist is best to go to.

In 1952, a well-known British researcher, Dr. H. J. Eysenck, shocked the world of psychiatry after making an intensive study of the results achieved by psychiatric treatment of neurotic patients. He found that “untreated” neurotics recovered from their deep emotional distress almost as often, and over the same length of time, as “treated” neurotics.

In short, he produced considerable evidence to prove what I have been propounding for many years; namely, even if you think you have a neurosis you should not get terribly upset. It isn’t as bad as it seems. Time alone may be your best doctor.

Most of us have common sense. Let’s use it.

What to remember about psychiatric treatment

1. A psychiatrist can treat you as a “whole” patient, physically as well as mentally.

2. Don’t be ashamed to seek psychiatric care if you feel you want it, or your doctor advises it.

3. In deciding whether you should go to a psychiatrist or psychologist, the best advice you can get will come from your family doctor.

4. If you want to obtain psychiatric care without going to your doctor for advice, be careful to avoid psychoquacks.

5. You can be guided to a reputable practitioner by seeking information from your local health department or by getting in touch with either the American Psychological Association or the American Psychiatric Association in Washington, D.C.

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