Psychiatrists are uniquely qualified to assess the mental, emotional, and physical aspects of psychological difficulties. As medical doctors, they are the only mental health specialists who possess a full working knowledge of the entire range of possible biological, psychological, and/or social causes for a patient's feelings, behavior, and symptoms/difficulties.
A psychiatrist's training is the most lengthy, rigorous, and comprehensive of all mental health providers. After college, a psychiatrist must complete four years of medical school to become an M.D. or D.O., followed by a year as an intern in a hospital setting, and three more years as a resident, in order to practice psychiatry. These training years are, for the most part, spent diagnosing and treating patients under the supervision of senior clinicians, in addition to didactic lectures, study, seminars, and other educational experiences. During the internship year, the psychiatrist-in-training spends 75-112 hours/week (as many internships require the doctor to be "on-call" for two to three 24-hour periods each week) responsible for implementing and managing the acute and ongoing medical care of patients in hospital and as outpatients. During the three residency years, the psychiatrist-in-training works 50-80 hours/week (2500-4000) hours per year responsible for and providing care to patients with every sort of emotional, cognitive, and behavioral difficulty.
Expert in complete and accurate diagnosis and treatment, psychiatrists may, depending on the nature of the patient's difficulties, recommend and provide appropriate psychotherapy, cognitive-behavioral therapy, medication, or other therapies designed to resolve or properly manage the problems that have brought you to treatment.
FOR A CHILD
The first line of defense when a child appears to be having problems is usually the family pediatrician. Since this physician has probably known the family for quite some time and is familiar with the family's history, parents may find it easier to talk over their concerns with him or her. The pediatrician will be able to determine whether there is any physical cause associated with the problem. If the problem is not severe or debilitating, the pediatrician also should be able to give useful advice on how to deal with the situation or help the child resolve it. Examples of problems for which parents might want to get a pediatric consult are bedwetting, general complaints of not feeling well without any apparent physical symptoms, refusal to go school, withdrawal from friends and family, and excessive complaints of stomachaches and headaches.
If the problem has gone on for a long time or appears to interfere with the child's ability to function or cope in general, a psychiatrist who specializes in the treatment of children or adolescents--depending on the child's age--should be consulted. The child's pediatrician should be able to refer parents to an appropriate specialist. Parents can also obtain listings of local psychiatrists from their local district branch of the American Psychiatric Association, community mental health centers, medical school, and the local medical society.
FOR AN ADULT
Adults who wish to obtain psychiatric help may want to start by conferring with his or her own physician. The physician will probably want to perform a thorough physical evaluation to check whether any physical problems may be the cause or a contributor to the mental or emotional problem. If the physician believes that psychiatric treatment is needed or could be helpful, he or she can recommend the names of psychiatrists appropriate to consult. Other listings of local psychiatrists may be available from the local district branch of the American Psychiatric Association, community mental health centers, medical school, and the local medical society.
(Adapted from APA's How to Choose a Psychiatrist Pamphlet)
- Individual, couples and/or family psychotherapy
- Group therapy
- Day treatment
- Partial hospitalization programs
- Intensive outpatient programs
- Inpatient hospitalization
- Drug and alcohol rehabilitation
- Residential treatment care
The term "mental illness" encompasses numerous psychiatric disorders. Just like medical illnesses that affect other parts of the body, a mental illness 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 character defect 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 as 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 non-depressed 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.
SOME WARNING SIGNS OF EMOTIONAL PROBLEMS
IN AN ADULT
A person with one or more of the following symptoms should be evaluated by a psychiatrist or other physician as soon as possible:
- 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
IN A CHILD
Having only one or two of the problems listed below is not necessarily cause for alarm. They may simply indicate that a practical solution is called for, such as more consistent discipline or a visit with the child's teachers or guidance counselor to see whether there is anything out of the ordinary going on at school. A combination of symptoms, however, is a signal for professional intervention.
- 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. (See American Academy of Child and Adolescent Psychology)
(Information from APA's How to choose a Psychiatrist Pamphlet)