Drowning in Doubts: Why I Think About Leaving Psychiatry

“90% of the people who enter my office are not mentally ill. They are having distressing emotional and psychological experiences. I would estimate 80% of these experiences are due to relational trauma, both current (abusive or unsatisfying relationships) and past (trauma inflicted by caretakers). These are very important problems; however, they are not medical problems”

This article has been written (within an American context) by E. Baden (not her full name) and published by Mad in America. It begins:

“I am an early-career psychiatrist and have been practicing adult, outpatient psychiatry as a part of a hospital-based mental health system in the U.S. for the past five years. I chose to pursue psychiatry because my favorite thing to do is listen to people. I am endlessly curious and interested in the human experience. I had a relative with schizophrenia who was shunned by his family and my heart went out to him and those struggling with similar experiences. I believed that as a sensitive, non-judgmental, and open-minded young woman, it would be an ideal career for me.

I started questioning psychiatry in my third year of residency. I read an article on tardive dysphoria, or antidepressant-induced chronic depression, that intuitively made sense to me. It was just logical that leaving people on these medications indefinitely would cause a person’s system to oppose the drug. I did a presentation on the renal effects of long-term lithium use which horrified me. I was saddened to learn that so many would go on to live with long-term kidney damage after decades on the drug. I also began to understand the risks of antipsychotics and watched their use expand in a way that, again, horrified me. I saw these potent and extremely risky medications being used for everything from insomnia to anxiety to behavioral control. Clinicians were prescribing them without respect or restraint.

Meanwhile, I became intensely interested in psychotherapy, which gave me hope and sustained me. This remains a joy to practice. However, no one is interested in hiring a psychiatrist to perform psychotherapy. I work in an underserved area, and as a concession they allow me to do a small amount of it to lure me to stay. I’ve come to see that employed positions are mainly interested in how much money you generate, which translates into seeing more patients than you can provide quality care for.

After five years as an attending psychiatrist, I have seriously considered leaving the field. It makes me very sad, as I love to practice psychiatry in its truest sense. A practice where I consider the myriad of factors influencing the patient’s emotional state and prescribe very little medication. I am an extremely critical psychiatrist, but I do believe mental illness—although rare— does exist and that medications used selectively, conservatively, and for the shortest duration possible are beneficial. However, 90% of the people who enter my office are not mentally ill. They are having distressing emotional and psychological experiences. I would estimate 80% of these experiences are due to relational trauma, both current (abusive or unsatisfying relationships) and past (trauma inflicted by caretakers). These are very important problems; however, they are not medical problems and should not be medicalized …”

You can read more from here.

Any reply would be very welcome

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