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What is a psychiatrist?

A psychiatrist is a physician who specializes in the diagnosis, treatment and prevention of mental illnesses and emotional problems. Because of extensive medical training, the psychiatrist understands the body's functions and the complex relationship between emotional illness and other medical illnesses. The psychiatrist is thus the mental health professional and physician best qualified to distinguish between physical and psychological causes of both mental and physical distress.

Why do people go to a psychiatrist?

People seek psychiatric help for many reasons. Life's usual round of trials may become overwhelming. Relationships may become troubled, or the pangs of anxiety--easily dismissed before as simple "nerves"--may grow sharper and last longer. The fresh-faced young newcomer down the hall at work may seem to threaten a secure job, and headaches may start to come literally one after the other. The emotions that arise in reaction to everyday stresses and strains may blow badly out of proportion, or may be strangely absent. Eating may become a refuge, and sleep may begin to seem either irresistible or elusive. Alcohol or drug use may get out of control.

The problems can be sudden, such as a panic attack or as frightening hallucinations, thoughts of suicide, or "voices" that whisper intrusive and incomprehensible things. Or they may be more long-term-such as a pall of gloom that never seems to lift, causing everyday, life to feel distorted, out of control, not worth living.

How do psychiatrists tell what is wrong with their patients?

Because they are physicians, psychiatrists can order or perform a full range of medical laboratory and psychological tests that provide a complete picture of a patient's physical and mental state. Their education and years of clinical experience equip them to understand the complex relationship between emotional and other medical illnesses, evaluate all the medical and psychological data, make a diagnosis, and develop a treatment plan.

What treatments do psychiatrists use?

Psychiatrists use a wide range of treatments-including various forms of psychotherapy, medications and hospitalization according to the needs of each patient.

Psychotherapy is a systematic treatment method in which, during regularly scheduled meetings, the psychiatrist and patient discuss troubling problems and feelings. The physician helps patients understand the basis of these problems and find solutions. Depending on the extent of the problem, treatment may take just a few sessions over one or two weeks, or many sessions over several years.

Psychiatrists use many forms of psychotherapy. There are psychotherapies that help patients change behaviors or thought patterns, psychotherapies that help patients explore the effect of past relationships and experiences on present behaviors, psychotherapies that treat troubled couples or families together, and more treatments that are tailored to help solve other problems in specific ways. Psychoanalysis is an intensive form of individual psychotherapy which requires frequent sessions over several years. The psychiatrist, who must have additional years of training in psychoanalysis, helps the patient to recall and examine events, memories and feelings from the past, many of them long forgotten, as a means of helping the patient understand present feelings and behavior and make changes as necessary.

When do psychiatrists use medications?

In the same way that your family doctor can prescribe medications to help patients with high blood pressure or thyroid problems, psychiatrists can prescribe a number of medications that are effective against mental illnesses such as depression, manic-depression, panic disorder, anxiety disorders, obsessive-compulsive disorder and schizophrenia. Psychiatrists use medications when thorough evaluation of a patient suggests that medication may correct imbalances in brain chemistry that are thought to be involved in some mental disorders. Psychiatrists usually use medications in combination with psychotherapy.

How does one become a psychiatrist?

A person wanting to become a psychiatrist must complete high school and college before entering medical school. While there is no requirement for a particular major, college students headed for medical school take required courses in the biological and physical sciences (general and organic chemistry, physics, biology, mathematics) as well as liberal arts courses. The prospective psychiatrist may also study social and psychological sciences and psychobiology. Most psychiatrists and other physicians feel that a liberal arts college education is the best preparation for medical school.

Medical students follow a standard curriculum, with only a few opportunities for choice. In addition to chemistry, biochemistry and physiology, students take courses in psychiatry, behavioral science, and neuroscience in the first two years of medical school. In the last two years, students are assigned to medical specialty "clerkships," Where they study and work with physicians in at least five different medical specialties. Medical students taking a psychiatry clerkship take care of patients with mental illnesses in the hospital and in outpatient settings. They also have an opportunity to work with medical and surgical patients who may have psychiatric problems or who have difficulty coping with their illnesses. Because modem psychiatry places special emphasis on the relationship between mind and body, students pay special attention to issues of stress and physical illness, prevention and behavior change, in addition to learning to care for severely mentally ill patients. Newly graduated physicians take written examinations for a state license to practice medicine. After graduation, doctors spend the first year of residency training in a hospital taking care of patients with a wide range of medical illnesses. The psychiatrist-in-training then spends at least three additional years in a psychiatric residency learning the diagnosis and treatment of mental illnesses, gaining valuable skills in various forms of psychotherapy and in the use of psychiatric medicines and other treatments.

After completing their residency training, most psychiatrists take a voluntary examination given by the American Board of Psychiatry and Neurology, to become a "board certified" psychiatrist.

Can psychiatrists become "sub specialists?"

Yes. Many psychiatrists continue training beyond the initial four years. They may study child and adolescent psychiatry, geriatric psychiatry, forensic (legal) psychiatry, administrative psychiatry, alcohol and substance abuse psychiatry, emergency psychiatry, psychiatry in general medical settings (called "consultation/liaison psychiatry"), mental retardation psychiatry, community psychiatry and public health, military psychiatry and psychiatric research. Some choose additional training in psychoanalysis at special psychoanalytic institutes.

Where do psychiatrists work?

Because of a continued shortage in the field, psychiatrists have many career opportunities. They work in a variety of settings including general and psychiatric hospitals, university medical centers, community agencies, courts and prisons, nursing homes, industry, government, military settings, schools and universities, rehabilitation programs, emergency rooms, hospices, and many other places. About half the 42,000 psychiatrists in the nation maintain private practices.

The hallmark of a psychiatrist's career is diversity and flexibility. Although some psychiatrists prefer working only in one setting, others work in several areas, combining, for instance, a private practice with hospital or community mental health center work.

Practitioners set their own work and time commitments according to their personal lifestyles and needs.

Also, because mental illnesses affect all races, ethnic groups and cultures, the specialty of psychiatry offers special opportunities for members of minority groups.

How much do psychiatrists earn?

Psychiatrists earn about the same as pediatricians and family physicians, depending on the type of practice, hours worked, geographic location and whether the psychiatrist works in the public or private sector.

For more information--

About psychiatry: Office of Education American Psychiatric Association 1400 K Street, N.W. Washington, DC 20005

About medical school: Association of American Medical Colleges 2450 N Street, N.W. Washington, DC 20037

About mental illnesses and substance use disorders: Division of Public Affairs, Dept. CRB American Psychiatric Association 1400 K Street, N.W. Washington, DC 20005