Understanding Psychiatry Part 2: Psychologist, Psychiatrist or Neurologist?
Once we realize we need to seek help, we will likely encounter three primary types mental health professionals - a neurologist, a psychiatrist or a clinical psychologist.In this second segment of our 5 part series, we focus on understanding the difference between the various health professionals that are often involved with mental health issues so that we may choose who we'd like to see and what services we can expect from each professional.
Neurologist or Psychiatrist
Psychiatrists and neurologists are both medically trained doctors. They have graduated from medical school with an MBBS degree and have pursued their medical specializations in psychiatry and neurology respectively. With these qualifications, both are equipped to treat with modern medication only.
The difference, simply put, is that a psychiatrist is a doctor of the mind and a neurologist is a doctor of the brain.
This is a very crude and simplified difference, just to help us learn. According to modern medicine, diseases of the mind do arise from the brain. As science has progressed, psychiatrists and neurologists have developed different and sometimes complementary core competencies.A neurologist will work with disorders that may not have any direct impact on our daily functioning, our moods, behaviors and thoughts. For instance, numbness in parts of our body, tingling in our extremities: in and of themselves, they do not always cause changes in our moods, thoughts and behaviors. Other more severe neurological disorders include stroke, paralysis, hemorrhage, multiple sclerosis, epilepsy and brain damage. Within these, the primary complaint is not of changes in the mind or behavior. If there are, these are secondary to the neurological or medical disease process, and can be treated accordingly by the neurologist zirself* or a psychiatrist.
Many neurological conditions such as multiple sclerosis and Huntington's disease can also present with psychiatric symptoms. A psychiatrist knows when the symptoms are from a core psychiatric illness and when it is secondary to another disease.
A psychiatrist will diagnose and treat mental disorders of mood, thought and behavior. These will include depression, bipolar, anxiety disorders of all types, psychosis and schizophrenia, and even addiction disorders. Psychiatrists are also best suited to work with childhood and developmental disorders such as attention-deficit/hyperactivity disorder. The primary complaints for a psychiatrist will include significant changes in one's mood, thought and behavior. These will likely not lead to a search for an organic cause (though of course they may be pursued in rare or severe cases.) All of these are also clearly outlined in guiding manuals such the International Classification of Diseases (ICD, by the World Health Organization) and Diagnostic and Statistical Manual (DSM, by the American Psychiatric Association).Confusion can arise in the case of overlapping illnesses such as autism spectrum disorders (ASD) and dementia. In ASD, there is certainly an organic component, but treatment protocols have evolved such that this and even other childhood disorders fall within the purview of psychiatrists who work along with the child's pediatrician. Similar treatment paths may be followed for intellectual disabilities.Dementia too is both structural and functional in nature. While dementia can be mapped using brain imaging techniques, it impacts our moods, thoughts and behavior, and even personality. While a neurologist will try and stop the brain from degenerating, a psychiatrist will help with feelings of sadness or mood swings that can also characterize dementia. One or the other can manage this condition, as can both as a team. Another example of overlapping territory is epilepsy.
Clinical Psychologist or Psychiatrist
First, a clinical psychologist is not a medical doctor. They are not medical school graduated, and therefore cannot prescribe medication.
Instead, they are graduates in psychology with degrees and specializations in clinical psychology. They may have further qualifications in types of therapies.
Trained in India, a clinical psychologist must have at least an MPhil. Along with that, they may also have a PhD in psychology. Importantly, in India, a PhD alone does not qualify or train someone to be a clinical psychologist. In any case, neither an MPhil nor a PhD, nor someone with both can prescribe medication.Those trained outside of India may have a PhD or a PsyD, both will hold the "Dr" title. If it is a PsyD (doctor of psychology), the clinical psychologist need not have an MPhil since their training through their doctoral work is extensive in the field of clinical psychology. If it is a PhD or a specialized Masters in clinical psychology from outside India, we might have to probe further about their clinical training, expertise and experience.
Please know that you can ask the mental health professional about their education and training.
A clinical psychologist is specially trained in non-medical therapies that help manage and treat mental disorders. The most common form of such therapies are talk based, where we go and speak to them about what's on our minds. Based on their trainings, they will use special skills and therapeutic protocols to guide and assist our recovery.
Clinical psychologists and psychiatrists both work with disorders of the mind, manifesting in thought, emotion and behavior.
We use the term clinical psychologist, and not just psychologist, to mark an important difference between clinical psychologists and other kinds of psychologists who may or may not be mental health professionals. Other kinds of mental health professionals may work as speech therapists, social workers or counselors, though by virtue of only these qualifications, none are equipped to deliver talk based psychotherapy.
Clinical psychologists deliver talk therapy and psychiatrists largely prescribe medication.
Psychiatrists are also trained in psychotherapies, although clinical psychologists have more in depth training as non-medical therapies are their core competence. In an ideal world, the clinical psychologist and psychiatrist will work together and with us to develop the best possible treatment for us. Since this does not always happen, we can proactively encourage them to communicate if necessary.It’s important to note that it is not true that all psychiatrists will medicate us, no matter what. They too can be spoken to, asked for advice, and simply consulted - taking medication for them is a shared decision.
In the next segment of Understanding Psychiatry with Dr Tiwari, we talk more about some of the ways in which we can be prepared for our first visit to a psychiatrist. The fourth segment discusses the ways in which this medication works and some of the issues we may encounter when taking these medications. We also talk about different psychotropic medications and things we should all know if we choose to use them. In the last segment, we examine the principles and shared process by which diagnosis are formed and psychotropic medication delivered.
