Psychiatrists are medical professionals that specialize in prescribing medications to treat mental disorders. They have attained their certification as a medical doctor, but have completed additional schooling to treat individuals with complex disorders of the brain. If you need treatment with a pharmaceutical drug for a mental illness (e.g. depression), a psychiatrist will be most equipped to devise a treatment plan.
Prescribing pharmaceutical drugs to treat mental illnesses is an imperfect science. Most people visiting a psychiatrist are dealing with so much psychological pain, that they want immediate relief. The job of a psychiatrist is to accurately assess the individual, properly diagnosing them with a mental illness or neurological condition.
Following diagnosis, the psychiatrist will generally write up a prescription for a drug that is most likely to address the diagnosed condition. The prescription pill is believed to help an individual get “back on track” with his or her life. Unfortunately, many patients visit a psychiatrist thinking that the psychiatrist is some omniscient “cure” god and that the prescribed medications will “cure” their mental illness.
10 Biggest Problems with Psychiatry
While psychiatry can be beneficial as a last-resort option, it should never be considered a first-resort. The field of psychiatry is riddled with problems including: misdiagnoses, incentivized prescriptions, and theorized prescribing of drugs. Turning to a psychiatrist to correct your neurochemistry is like turning to a mechanic to fix your car – except the mechanic cannot look under the hood to determine the specific problem.
1. Inaccurate diagnoses
The biggest problem with psychiatry is when individuals are misdiagnosed and/or wrongfully diagnosed with conditions they don’t actually have. For example, someone with a flat affect may be assumed as having schizophrenia, when in reality they could just have severe depression (this happened to me). If the psychiatrist strongly believes that the person has schizophrenia, the person will get prescribed antipsychotics.
Someone taking these antipsychotics may then start to fit the “mold” and resemble someone with schizophrenia. Even when they withdraw from them, they may experience psychotic symptoms and now convince themselves they have schizophrenia. It is common for antipsychotics to cause psychosis upon withdrawal – even among those with normal mental health.
It is also extremely common to get misdiagnosed with bipolar 2 disorder. If you so much as experience hypomania as a result of ingesting a potent antidepressant, your psychiatrist may assume you have bipolar 2 – rather than understanding that this mood change was likely triggered by the antidepressant. Even if you had never experienced hypomania before in your life – you now have a new (misdiagnosed) label of BP2… the joy.
Inaccurate diagnoses could potentially send you down a very ugly chemically-altered rabbit-hole – potentially for the rest of your life. Unless you escape the psychiatric matrix and realize that you’ve been misdiagnosed, you may convince yourself that the psychiatrist was 100% accurate and that you must be submissive to the suggested (mis)-diagnosis. Oddly enough, their diagnosis was made without actually looking at your brain; they just made a (hopefully logical) guess based off of some paperwork, surveys, and talking to you.
2. “Chemical imbalance” theories
Nearly every psychiatrist subscribes to the believe that mental illnesses are caused by “chemical imbalances.” To get more specific, they believe that if you have a mental illness, it’s probably caused by too much of neurotransmitter “X” and not enough of neurotransmitter “Y.” The only way to correct this lifelong inheritance of a chemical imbalance is with their magic medications.
While some people may have a chemical imbalance, there’s no telling whether the illness is caused by the chemical imbalance or whether the chemical imbalance is caused by the illness. If the chemical imbalance is caused by the illness, then the drug being used to treat it may not even help the problem. Furthermore, even if a chemical imbalance is part of the problem – it’s probably not accounting for the big picture; there are likely other things wrong.
The theories of a “chemical imbalance” are based off of the idea that taking an SSRI for example helps treat depression. SSRIs are proven, effective treatments for depression – so therefore low serotonin was the direct cause of depression, right? Wrong – this assumption is extremely myopic.
Assuming low serotonin was the cause of depression because a person responded well to a serotonin increase is like assuming low endorphins caused a person’s depression after they report feeling euphoric on an opioid. The same goes for an amphetamine – I could take an Adderall for depression, get relief, and then suggest I was really just deficient in dopamine. In reality it’s a lot more complex than just neurotransmission.
In many cases, psychiatrists fail to understand that the medications they dole out consistently are actually creating chemical alterations. In other words, a person with depression may take an antidepressant, only to develop an antidepressant-induced chemical imbalance. The person may have never had a problem with their neurotransmission – their depression may have been from a vitamin deficiency or toxic mold – but now they’re left with the root cause and a new imbalance that can only be mitigated with the drug they had been taking.
3. Prescribing temporary “patches”
Every pharmaceutical drug that is prescribed to treat psychiatric conditions is nothing more than a temporary patch. The idea that pharmaceutical drugs are acting as a “patch” is assuming that they’re helping reduce symptoms in the first place – many people get no relief or even feel worse. In this case, the drug would be more like poking a knife inside of an open wound, hoping that it would heal.
Assuming you do get some relief from the medication that is prescribed, there’s no telling how long the relief will last. Many people notice that their antidepressants stop working over an extended period of time. The reason the antidepressants (and other psychiatric drugs) stop working is due to tolerance – over time, your body adapts to the drug and it loses effectiveness.
When the drug(s) stop working, this leaves you stuck between a rock and a hard place; you have limited options. At this point, all you can do is either: increase the dosage and hope that the higher dose works (while dealing with more intense side effects), discontinue the drug (enduring the wrath of withdrawal), and/or play antidepressant roulette by switching to a new drug hoping that it’ll miraculously reduce your symptoms.
No drug is meant to be taken over the long-term with efficacy. These drugs are not addressing the root of the problem, and in many cases are masking traumas that would be better dealt with in therapy. The problem with using a temporary patch is that you’ll forever be reliant upon and at the mercy of a chemical for the sake of your mental health.
4. Poor understanding of pharmaceutical drugs
Though psychiatrists understand the mechanisms of the pharmaceutical drugs better than most patients, many mechanisms of action remain unknown. You may understand that SSRIs all primarily target serotonin, but the secondary and tertiary subtleties of the mechanisms between Zoloft and Prozac are very different. This is why one drug may be effective, yet another won’t – even though they both increase serotonin.
We don’t know the full cascade neurophysiological effects that are associated with each pharmaceutical drug prescribed. No two pharmaceutical drugs are the same, and no two people have identical neurophysiological signatures. Therefore it is nearly impossible to predict the exact effects of these drugs.
Certain substances are considered “effective” treatments, but mechanisms are poorly understood. Psychiatrists are prescribing medications to patients based off of a theorized diagnosis (based on symptoms) stemming from a theorized chemical imbalance. The drugs are theorized to work a specific way, but the precise mechanisms of action cannot be confirmed.
5. Failure to look at the brain
To make the diagnosis of diabetes, blood samples are taken. The blood samples are then assessed to determine the amount of glucose (sugars). In psychiatry, doctors don’t look at the actual part of the body that they’re treating: the brain. This is due to the fact that brain scans aren’t yet able to predict whether someone has bipolar disorder, schizophrenia, depression, or anxiety.
That said, it’s not like we don’t have any technology available to help get a better understanding of what’s really going on in the cortex. Two people may report having significant anxiety, but one person’s anxiety may be caused by lack of blood flow to a certain region, while another person’s may be caused by excessive high beta brain waves. To improve psychiatric treatment outcomes, it is necessary to look under the hood.
Most mechanics take a look under the hood to determine what’s wrong with the engine of your car when it’s not working properly. However, most psychiatrists don’t even make an attempt to look at the brain via brain scans (PET, fMRI, QEEG, etc.) or physiology (via blood draws) when a person reports feeling amiss. From here they may hand out a survey or mood assessment to the patient and conduct an in-person interview.
Unfortunately this interview is relatively meaningless without actually looking at the brain. What if the person has a tumor that is causing their symptoms? Now they are going to get wrongfully medicated instead of targeting the root cause. This is akin to a car mechanic handing you a survey and asking you a few questions – they may make a correct diagnosis, but there’s a significant chance that they’re incorrect.
6. Overprescription of dangerous drugs
Many psychiatrists fail to realize the dangers associated with many drugs that they commonly prescribe. Sure these drugs may provide patients with some short-term relief, but the long-term outcomes are often dismal. The most dangerously overprescribed class of psychiatric drugs may be the antipsychotics.
These drugs function by acting as D2 dopamine receptor antagonists. This means they bind to the dopamine receptors and render them useless to the stimulation of dopamine. This can be significantly beneficial for those with positive symptoms of schizophrenia, but should be considered a last resort.
Atypical antipsychotics are known to cause brain volume loss, significant weight gain, and possibly diabetes over the long-term. The reality is that these drugs are being prescribed off-label as antidepressant augmentation strategies, treatments for insomnia, and anxiolytics. While this off-label usage may be temporarily beneficial, the long-term effects could be disastrous.
Other drugs like benzodiazepines are still commonly prescribed to treat anxiety disorders. These drugs have a rapid-tolerance onset, can cause dependence, and the withdrawal could be deadly. To make matters worse, there is mounting evidence that benzodiazepines are linked to dementia and permanent memory impairment.
These dangerous drugs are still commonly prescribed, and other drugs that aren’t considered “dangerous” could be in upcoming years. Just wait a decade or so to see the hottest drug now be associated with condition “X” and lawyer commercials getting spammed across TV to sue the manufacturers.
7. Lack of empathy
Certainly not all psychiatrists are cold-hearted pill-pushers, some will listen to the patient and show some degree of empathy. However, many are on a mission to get the patient “in-and-out” of the office as fast as possible. They’ll ask how the treatment is going, if it’s not going well they’ll throw another pill at the proverbial “wall” (your nervous system) and hope that something sticks (i.e. helps).
The overwhelming lack of empathy in the psychiatric community is harmful to the patients. If a patient has a concern regarding side effects or withdrawals, don’t just tell them that the medication isn’t “associated with that.” Years ago antidepressants were thought to have NO withdrawals.
I told my psychiatrist that I was experiencing withdrawal symptoms from Paxil and he looked at me like I must’ve been naturally becoming more mentally ill. Just because something isn’t yet in the medical literature does not mean that it doesn’t exist. Now psychiatrists know better and will tell people to gradually taper to avoid discontinuation symptoms.
Many psychiatrists project themselves as intimidating and aren’t as down-to-Earth as they should be. Most patients are walking into their office, hoping for some sort of collaborative effort to get better. Instead, they end up walking right into a dictatorship with a psychiatrist on a power trip – thinking he or she always knows best; sometimes not even listening to or acknowledging concerns of the patient.
8. Perverse incentives
Each year billions of dollars get funneled into promoting the living hell out of pharmaceutical drugs. Many of those drugs just so happen to be psychiatric drugs. The newer the drug, the greater the amount of money the pharmaceutical manufacturer stands to make with each additional prescription.
To maximize sales, the pharmaceutical reps flag down psychiatrists, wining-and-dining them until they’re ready to push the new drug. Some psychiatrists get financial bonuses, vacations, and free meals for pushing certain drugs over others. It’s a competitive world out there and certainly not all psychiatrists can be trusted.
In recent years some have been caught and legally penalized for prescribing certain drugs off-label or intentionally misdiagnosing patients to prescribe a certain drug. Dr. Michael Reinstein is just one example of many psychiatrists who prescribe the living bejeezus out of a specific drug (usually brand name) for perverse compensation. Certainly not all psychiatrists are like this, but it’s important to beware of the ones that are more in it for the money than actually helping people.
9. Failure to consider individualized neurophysiology
What’s more accurate: Anecdotal information from a patient or information from a scientific journal? While it’s easy to assume that the information from a scientific journal is always the most accurate, this clearly isn’t always the case. Just because the majority of people are able to tolerate gluten doesn’t mean that everyone is.
Assuming that everyone should have the same set of side effects, withdrawal symptoms, and respond to the same dosage of a drug is blasphemy. Unfortunately if a person gains weight on a drug that isn’t associated with weight gain, a psychiatrist may wrongfully assume that the weight gain is because the patient was irresponsible with diet and/or exercise. In many cases, the weight gain may have been a result of the person’s unique neurophysiology.
Individual differences in brain waves, neurotransmission, blood flow, regional activation, nutrition, etc. – should be considered. Additionally, individual sensitivities to dosage and certain classes of medications should be considered. For example, someone who is sensitive to antidepressants should probably only start with the minimal effective dose – rather than a dose on the higher end of the therapeutic spectrum.
Another person may need a higher dose in order to get relief. Although some psychiatrists treat their patients on a highly-individualized basis, many fail to do so.
10. Outdated practices & misinformation
The field of neuroscience is just starting to gain some momentum in terms of advancement, but knowledge of how the brain works is still severely lacking. The bits of knowledge that are available can be helpful, but they aren’t providing the bigger picture. Psychiatrists attain information from schooling, experience, and on occasion – the latest medical journal.
Many psychiatrists fail to adapt to the latest findings, and are stuck with information they’ve retained 20 years ago. Sure they may have a lot of “experience” in the field, but they aren’t up to date with the latest information. Staying up-to-date with psychiatry requires constant ingestion of new scientific literature. The new literature may provide some insight into why a certain patient fails to respond to traditional treatments.
By adapting to the times, psychiatrists can continue to improve their practice by making more accurate diagnoses and treatments. An outdated practice today may cause significantly more long-term harm than benefit to patients. It’s possible that the “truths” of present-day psychiatry may be completely shattered in another 15 years.
What should you do if you have a problematic psychiatrist?
If you have a problematic psychiatrist, you may want to consider transitioning to one with whom you have better “chemistry.” Some psychiatrists are well-intentioned, but clearly aren’t well-equipped to decipher your particular mental illness and work with you to treat your condition. If your psychiatrist seems as if he or she is unwilling to listen to your concerns and lacks empathy for you as a patient, you may want to run for the hills. (Read: What to Look for in a Good Psychiatrist).
My first psychiatrist was like a robot and wrongfully wanted me to take antipsychotics as a young teenager. He suggested that I was likely developing schizophrenia – an illness that I have never gone on to develop and I have no history of this condition in my family. Unfortunately he was a pill-pushing dictator who thought he knew my own experience better than me.
I’m thankful to have found a much more competent psychiatrist since leaving him. My new psychiatrist conducted significantly more thorough analyses of my blood, cognitive function, and took into account my concerns for side effects with certain medications. He also accounted for individual differences in the subtype of my particular depression and anxiety – and actually recommended some alternative non-pharmaceutical adjuncts (e.g. mindfulness).
Have you encountered problems with your psychiatrist or psychiatry?
If you’ve encountered problems with your psychiatrist or psychiatry as a general practice, feel free to share a comment below. Mention what you found most problematic with your psychiatrist (e.g. diagnoses, prescriptions, etc.) and/or the field of psychiatry. If you currently still see a psychiatrist, do they listen with empathy and treat you like a human being? Or do you feel like just another cog in the machine?