I know she (the clinical psychologist) meant well. I know her presence there was designed only to make me feel more comfortable. But I wonder how he felt (the psychiatrist), having his diagnostic interview scrutinised by her (a senior psychologist).
Was he behaving naturally? Or was he putting on a show for her? as well as patient me.
It’s difficult, I imagine, to be someone’s psychologist (who has known and worked with pre and post breakdown in therapy), and to watch on passively while someone tries to psychiatrically interview/ diagnose your patient.
She (the senior clinical psychologist) knows me so well. He (the psychiatrist) has known me, by contrast, for somewhere approaching four hours. Yet he yields ALL the diagnostic and decision making power.
He is the one asking me the questions, and I am the one telling him what I think is important to describe, but what did that third party observer actually think? She jumped into the conversation and helped me out a few times. She added bits which were right to be added; bits that I was too mentally and emotionally overloaded in that situation to say. She also reinforced bits that I said, by saying words to the effect of “yes psychiatrist man. Definitely include this in your diagnostic report- this particular shit matters very much.”
But I guess she might have felt a little powerless? Not used to being in a situation where she was not the primary mental health professional leading the clinical patient/professional dance.
So what is the difference between clinical psychologists and medically trained psychiatrists? Psychologists in the UK (and I assume worldwide) are not allowed to make diagnostic decisions about their patients or clients. They can offer suggestions, but they cannot impose their professional opinion to the extent that they can make an official mental health diagnosis that adorns your medical records. (They also cannot prescribe meds).
That is the diagnostic power only reserved for the Jedi. (The psychiatrist/the person you call Doctor.)
“The Jedi” was the main nickname for my previous psychiatrist….
The psychiatrist is a professional that yields their power like a DSM/ICD aware light sabre. Whoosh. Whoosh. I have the power! etc etc. (The DSM and ICD are the manuals listing the criteria for each subtype of mental illness).
But it is the clinical psychologist that usually knows you way better than the diagnostic power yielding light sabre-ish doctors of mental health medicine-the psychiatrist.
Clinical psychologists offer the therapy that is there to facilitate improvement in your management of your illness. Doctors usually only offer prescriptions and their opinions.
Clinical psychologists are the class of professionals in the mental health world that I admire the most. Is that only because I’m a psychology graduate myself? 😛 Am I just biased towards protecting my own discipline or school of study?….. Well, I don’t think so. I have the upmost respect for them because they help me the most. I have worked with three of them now, and they satisfy me emotionally and intellectually in a way that just doesn’t apply to community psychiatric nurses (CPNs), support workers, person centred counsellors and psychiatrists.
But the psychiatrist has the power. They can detain you under the mental health act (in other words ‘section’ you). They can change your medication. They can take away your driving license even.
The doctor ALWAYS has the most power. Yet they spend the LEAST time with you! and understand your complexity and set of symptoms THE LEAST.
Usually in a community mental health interdisciplinary team, or a hospital equivalent- the psychiatrist is invariably the lead professional (in ultimate charge of a mentally unwell patient), but who said psychiatrist’s must be in the lead. What race did they ever win to determine they would be the designated top dog of mental health care?
They don’t spend fuck all time with you! So how can they be most critically important in a interdisciplinary team of mental health professionals?
A medication review can take as little as 15 minutes. A full psychiatric history can be taken in as little as an hour and a half. I spent 4 hours with this psychiatrist in this case, spread over two appointments, but that was only because he TALKED SO FUCKING MUCH HIMSELF!! I would estimate about 70% of the time spent with me with him talking! And not only that, he yields 100% of the power.
He has the power to talk at length about what the hell he wants to talk about. He has the power to the set his own diary of appointments and manage his time. He also has the power to change your diagnostic assessment appointment into his own wannabee TED talk! Which brings me onto the key hypothesis of this post (which may well offend psychiatrist’s or partners of psychiatrist’s, so please stop reading now if you are associated in any way with this breed of Jedis).
I think it is maybe impossible for a psychiatrist to do their job, without, over time, developing certain personality traits of narcissism (if they are not already a narcissist)
Boom. I said it!
I will let my (provocative) hypothesis sink in for a moment…..
I have not so far met a psychiatrist that I have NOT detected some evident narcissistic traits in!
I liked the doctor I saw, don’t get me wrong. He was very helpful at times, very sweet and considerate, and also very personable and engaging, dare I say charismatic. I don’t dislike him at all, and this post is not a personal slur on him, per se. I am merely making a sweeping generalisation (which may or may not be true 😂😂) that grandiosity is a trait I have seen time and time again in all the doctors/Jedi’s I’ve come across.
From their point of view, I think it must be potentially very difficult to perform that role and yield that level of power over others on a daily basis without eventually starting to actively enjoy that power and basically starting to believe your own hype. Patients and other clinicians and organisations deferring to you and obediently responding to your requests and listening to your opinions as though they are fact, AT ALL TIMES, must evidently go to your head after a while.
You are the doctor. Therefore you are the ultimate god/goddess of mental health professionals. Truth. Sorted. No questions asked. End of sentence. Done.
Psychiatrists, in my experience, tend to present opinions as though they are facts.
Sometimes they will even fall back on the classic cliché of saying “I’m a doctor”. [Ergo I know this to be true?]. They will typically remind you they are a doctor, either before or after they state their OPINION, and they think we will therefore respond to their opinion as though it were truth; an unequivocal fact.
TRUST ME, I HAVE A DEGREE IN MEDICINE. THEREFORE I AM ACTUALLY AMAZING AND INVINCIBLE AND BLOODY FANTASTIC.
But most clever people know that there is no such thing as a fact. There are instead multiple truths, and multiple angles, and multiple hypotheses which all need and demand our attention.
In my blog, I will admit to often presenting my opinions in a very definite style, but this is blog life, not real life, and the only humans I really exert any proper influence over in my real life are my children (and husband in times of PMS!).
I am not a doctor or practising psychologist. I have no power. I only have blogger power, by stating my words as though I mean them, but most of the time I simply present my opinions in definite ways when blogging just because it’s my blog innit- my place to express myself in a very self-expressive cathartic way. But doctors do blogging (not literally, but metaphorically) by expressing their opinions as facts in their professional lives every day. No wonder they develop a grandiose sense of their own importance as they play doctors with their sectioning/diagnosing/prescribing light sabres.
It is IMPOSSIBLE for me to meet a psychiatrist without getting a comical picture in my mind develop of them yielding a light sabre, complete with whooshing noises, as they make a point of psychiatric importance, in their’ doctor-ish I’m in charge’ way. It makes me want to giggle and blurt out my hypothesis that they are
some of them mainly all of them are total narcissists, and this makes me wanna LOL.
This is how I visualise them. (I am the unicorn).
I have a brother who is a doctor, and also a narcissist, so I have observed a doctor’s narcissism at very close quarters. I have the insiders view of narcissistic doctors, because I listened to all the narcissistic bollocks he used to say away from the consulting room, about his patients. He was not a psychiatrist- he was a GP, but a narcissist he most definitely was. And that is what I see in all the psychiatrists I’ve ever seen, therefore it MUST be true!
To sum up, psychiatrists are Jedis, and narcissists, who present opinions as facts, who believe they are the best, who never tire of reminding people “I AM A DOCTOR, don’t you know,” before they make their educated guesses about what is wrong with you and how you can be helped, as though there is no other option available, and meanwhile, the clinical psychologists, who actually KNOW YOU and spend decent amounts of time with you, and understand you inside out, do not get awarded that same level of respect.
The psychiatrist I saw, did a whole lot of stating the bleeding obvious, making patronising suggestions to my clinical psychologist/therapist about simplistic treatment strategies that she started doing FOUR FUCKING YEARS AGO, as though they were startling revelations, and not only that, he prefaced every sentence he said by saying I AM A DOCTOR, as if it were possible for me to forget. He is a doctor, therefore he is God, and the Jedi, and clinical psychologists and patients must do the fucking obvious things he says we must do, and then I will get better and all will be well.
For a doctor who claims to be the expert, my faith is in my psychologist, who has a clinical doctorate but does not call herself a doctor. She quietly goes about trying to help me week in week out, with no fanfare, no prefacing everything she says with I AM A PSYCHOLOGIST, THEREFORE THIS IS SURELY TRUE, and she does not have that narcissism that seems to me to be reserved for the doctor of medicine.
What do you think of my cheeky hypothesis? Do you observe grandiosity and arrogance in the psychiatrists/doctors you see? What is your view of the usefulness of psychiatrists, relative to other mental health professionals? Is your psychiatrist a Jedi? And next time you meet them, will you be visualising them showing off, yielding a whooshing I am a dfoctor therefore I am most clever and important light sabre? I know I will ;)