Psychiatry & Counseling - The Great Divide

I started another post but couldn’t really address that topic without addressing this first. The divide between psychiatry and counseling, in short, needs to be bridged. Anyone who has ever spent time in the mental health system knows that it is incredibly flawed. Now, everything man made is flawed because there is no way for man to create a perfect system when we ourselves are not perfect. However, it could be vastly improved.

The separation between psychiatry and counseling goes waaaaaayyy back and is too much to get into here. Essentially, psychiatry began as a form of medical science, and counseling was an offshoot of that as more of a social science. It’s continued that way over the decades for no real reason other than tradition, and is doing a great disservice to mental health clients. Many people in the mental health system (and certainly the majority who are diagnosed with a serious mental health condition) partake in both psychiatry and counseling services (and sometimes even more services such as dealing with case workers/social workers, etc.) Yet often, there is no communication between the psychiatrists and counselors. This is a BIG problem. Psychiatrists are the ones prescribing mind altering, behavior altering psychotropic medication, yet they (for the most part) do not address “life issues”. In order to deal with your “life issues” you must turn to your counselor.

Now I’m just going to talk a little about my own personal history to make a point here.

When I was a teen I was in the mental health system for a time, and I recall then the horrible discrepancy between psychiatry and counseling. The counselor I had dealt with the “social” issues and the psychiatrist with the “biological” issues. The counselor was the one meant to help me actively work on or deal with my issues, while the psychiatrist was giving me medication to treat these issues, and I doubt they ever spoke to each other about my case. See the problem here? Biology and social factors influence each other tremendously, and a holistic view should be addressed when dealing with mental health patients. However, it seems to be one of those things that no one WILL address. Maybe because if clinicians did address it, it would be to admit the system is lacking and really does not work efficiently.

Fast forward about 10 years. If you’ve followed my blog or videos, you know that I was hospitalized in 2010 and diagnosed with bipolar (essentially self-diagnosed). There were no counseling services available while I was an inpatient (about a week stay). I met with the psychiatrist daily or every other day and he/they prescribed me medication (I saw a woman once, then a man the rest of the time). I spoke briefly with a social worker once (who was the closest I got to a counselor). I had to retell my story to about 5 different people in the system and that was mental agony in itself. Essentially, I had to wait until exiting the hospital to even begin counseling, so those 5 times I retold my story were of very little help to me anyway. As you can see, there was a whole lot of jumbled up stuff going on then.

The only real “counseling” that occurred while I was hospitalized was between patients! Some of us would sit and discuss why were there, what had brought us there, etc. (in private, on our own, not assigned.) One woman, God bless her, was on somewhere around ten psychiatric medications at the time. Was that really necessary? I doubt it. They had been prescribed by different physicians as well. A very egregious lack of communication on their part. Another woman who was there for suicidal ideation, told me that talking to me had helped her more than any treatment she had received while there. I too felt after leaving that I really had received no help, other than some hastily prescribed medication and appointments for counseling and psychiatry to begin as an outpatient upon leaving. I remember addressing the lack of counseling with some of the staff. I was told that the hospital was simply to stabilize people and get them back to their lives where they could get long term help. Yet for some reason, counseling didn't seem to be viewed as important enough to begin while an inpatient! Basically, the psychiatrists gave out diagnoses, threw medication at a person and figured that was enough to help them until they could get into some regular services. 

However, I think often, the opposite would really have been the best. SO many people were there for suicide related reasons (the vast majority). Wouldn’t it seem that they would benefit more from a counselor to discuss things with than hastily prescribed medication? If it was a persons first admission, how could a clinician possibly have enough information in one short 30-45 minute session to know A) what the diagnosis is definitively and B) what to do about it? But again, the great divide prevails. I think part of the problem is that psychiatry and meds are often viewed as a quick fix, an "easier" fix, while counseling takes time. But that is such a wrong view. Meds are not generally a quick fix, nor are they something to take lightly. In my own view, in retrospect, I'd say even with a "serious" mental condition like bipolar, I benefited FAR more from counseling than medication. Counseling (when done correctly) can help teach a person how to live better, recognize things in themselves, make changes. Psychiatry relies on "correcting" problems in the blink of eye with altering brain chemicals, many times without even educating the patient about prescribed medications or alternatives. So often medication does not correct the problems and at times only masks them (or sometimes makes them worse.) Sadly, there are no pharmacological cures for mental illness. Why? because it isn't simply our biology...it is our social world, and our environment that also play a part of the symptoms we exhibit and the way we behave. You can't "treat" biology without addressing the social and you can't understand the social without understanding the biology when it comes to the brain.

Throughout my years of outpatient service, the majority of the time, I have had a psychiatrist and a counselor who not only did not communicate but did not even work in the same building or part of town. It was very much a singular effort on their parts rather than a joint effort when dealing with patients, and that is the commonplace way of dealing with clients in the mental health system. (I’m not saying anything negative against either my psychiatrist or the main counselor I had for several years. They were both very kind people that I liked.) But nevertheless, the fact remains that I have heard countless personal stories of others who have gotten so fed up with the system, they didn’t know what to do. Sometimes they quit meds, sometimes they quit counseling, sometimes they gave up entirely. The “med-merry-go-round” as it is known, is frustrating enough for patients, then add in dealing with multiple people, for multiple different things…and UGH. Just UGH. So, in short, Psychiatrist = meds, Counselor = listening/therapy strategies.

Psychiatrists and counselors very much rely on each other yet they are completely separate. You don’t tell your psychiatrist your problems for the most part (or, if you do have a caring psychiatrist who does listen, you still hear “You should probably tell your counselor about that.”)  If you try to discuss meds in the context of counseling or personal issues, you may get some advice from your counselor but ultimately, given that they don’t prescribe medication, the answer is “Talk to your psychiatrist.” Why is this? Mainly, because psychiatrists are licensed to dispense medication and not to counsel, and counselors are licensed to provide therapy but not medication (there are some exceptions but for the most part, this is how it works.) See the problem there??? I do.

In order to function in a more complete and indeed a more beneficial manner, the mental health field needs to move away from traditional roles of psychiatrist and counselor and integrate the two into one person. Anyone dealing with anxiety, bipolar, schizophrenia, or anything else, should be able to see ONE person who gets to know their case and manages it as such. They would know all the details of the person’s life, all the outlying factors, internal factors. They would be able to judge whether the person even NEEDS medication (because, many times, they don’t. Medication is, I believe, overprescribed and dispensed in a flippant manner although they are serious drugs, but that is for another post.) Sometimes, all a person needs is someone to listen to them and understand, and to help them in non-pharmacological ways. I think until such an integration happens, sadly, those receiving services from the mental health field will always be getting the short end of the stick.