There is often much confusion between the terms psychiatrist and psychologist. People may use these terms interchangeably, but this is not to be the case. While both psychiatrists and psychologists treat people suffering from mental health issues and behaviour disorders, they are not the same. When should I see a psychiatrist? Is psychiatry and psychology even the same thing? Who should I see first? Such thoughts may run through your mind when mental health treatment is brought up. In this article, we hope to clear the doubts and achieve greater clarity on who they really are and how they differ.
Before we begin, if you’re reading this article to find important insights on seeking help from a mental health professional, we would like to commend you for taking the necessary steps to help yourself or your loved one. Making such a decision can be very daunting, and your mind might be in a disarray with constant worries of familial, societal and cultural stigma. However, it is ever so important to remember that there is no shame or embarrassment in wanting to help yourself or your loved one get better. Mental health is equally as important as physical health and seeking help is a sign of strength rather than weakness.
What’s the Difference Between a Psychiatrist and a Psychologist?
Fundamentally, the biggest difference between the two is in the approach they take towards treating mental disorders, and the capacity to prescribe medications. Unlike psychologists, psychiatrists are trained medical doctors at their core. Amongst the network of mental healthcare professionals, psychiatrists are certified to provide neuropharmacological support that is deemed essential in stabilising certain mental conditions, such as where chemical imbalances in the brain are involved.
As medical doctors, psychiatrists play a crucial role in the diagnostic process, as well as the prevention and treatment of emotional, mental, behavioral, and developmental issues. While conducting assessments, they may also involve relevant physical examinations, blood tests, or pharmacogenomic testing to narrow down the scope of diagnosis. While psychiatrists specialise in the mental phenomena, such physical examinations cannot be omitted entirely especially if they provide important clues to help them rule out other possible physical conditions.
Psychiatrists also have the capacity to assess your medical history. Physical and mental wellness go hand-in-hand – psychiatrists will need to grasp the full picture before finalising on a diagnosis. On the Huffington Post, Carol W. Berman, M.D., a clinical assistant professor of psychiatry at NYU Medical Center in New York City, writes, “Because we learned how the body interacts with the mind, we can rule out physical disorders as a cause of mental illness. This is important, since a person may have a hyperactive thyroid, for example, which can trigger panic attacks, anxiety, insomnia, or anorexia. We can look at thyroid blood tests or have a patient consult an endocrinologist if we suspect the problem stems from thyroid disease.”
In contrast, psychologists are not trained medical doctors, and thus cannot conduct any physical examinations nor prescribe medications. Clinical psychologists however, possess an accredited Master’s in Applied Psychology at the very minimum, and can make a diagnosis for the patient if he thinks he has a mental health condition.
Psychologists typically make use of various methods of psychometric testing, personality tests, observations and interviews to come to a conclusion. But that’s not all – psychologists also engage in psychotherapy treatment, with common forms including cognitive behavioural therapy (CBT). Psychotherapy aims to help clients identify their key issues and concerns, before moving on to create a treatment plan to achieve the desired outcomes. Often conducted over several sessions, psychotherapy equips the individual with problem-solving and emotion-coping strategies to overcome the problem. For example, if a client comes in hopes of seeking help for social anxiety, psychotherapy (such as CBT) would be greatly beneficial in tackling maladaptive, limiting thoughts and behaviours that fuel negative emotions.
While there are differences in qualifications and the methods of treatments applied by psychiatrists and psychologists, it is key to note that they still work closely together. For the optimal treatment of certain mental health conditions, psychiatrists may refer you to psychologists for concurrent psychotherapy. Likewise, if a clinical psychologist determines your condition to be better managed with medications, a referral to a psychiatrist can be expected. Often once a proper diagnosis is done, the psychiatrist and psychologist may work together to build a treatment plan for the patient, focusing on managing symptoms through the use of medications and psychotherapy.
Who Should I See First?
Where physical symptoms may be severe, or where it may be hard to take basic care of yourself, turning to a psychiatrist would be a good option. After all, psychiatrists are trained medical doctors who can also work with your primary care doctor (if any) to provide optimal treatment. It is also suitable for individuals who are unsure as to whether their physical symptoms are linked to other underlying medical conditions. In such cases, psychiatrists will be able to detect a medical mimic. To put it simply, take for example a presenting complaint linked to the shortness of breath. While it may seem like a panic attack, it is crucial to eliminate any other clinical suspicions of lung diseases such as pulmonary embolism.
On the other hand, you may choose to make a trip to see a psychologist if you think you have a less severe mental condition. For individuals seeking to overcome phobias or resolve difficult issues in life, it may be more effective to undertake psychotherapy. A Psychologist can help you work through your problems, deal with emotional challenges or cope with particularly traumatic life events so as to make positive changes in your life.
We can all play a part in alleviating our own or our loved one’s suffering by increasing our understanding of mental health disorders. If you’re still struggling with making a decision after much thought, making the first step to contact a professional would help. You can be assured that the team at Promises will serve with your best interests at heart, and will work closely with you to provide optimal treatment.
Many of us are absorbed in an endless, self-defeating rat race. The nature of modern society has instilled in us a “winner/loser” mindset, and its systems highly prioritise external rewards and punishments as measures of our personal success and social worth. This oftentimes forces us to shift our perception of self-worth from the satisfying efforts of personal endeavour, to the critical imperative of achieving yardsticks of success defined by the rest of society. When we are constantly striving to win a race while focusing on external factors largely beyond our design or control, we’re surely putting ourselves at a disadvantageous position.
The overwhelming pressure to conform to societal expectations, or to outrun others in the race of life, can make one particularly susceptible to depression if negative emotions are not managed well. As we aim for perfection – as most people would – we need to understand that total perfection is unattainable. The more we believe that we have failed to reach a certain state of “perfection”, the greater the extent to which we experience low self-esteem, self-hatred, and depression. Depression can be extremely debilitating to one’s mental health. Apart from the diminishing enthusiasm for life and self-esteem, depressed individuals may self-isolate and pull away from their social circles, making it all the more difficult for them to get the help they need.
Perhaps one of the healthiest things we can do for ourselves is to accept who we are. Self-acceptance might just be the antidote to excessive self-resentment and discontentment. It is important that we fight against influences that force us to conform to certain standards rather than to accept ourselves. Presented below are a couple of talk therapy methods that we use to guide you towards achieving that.
What is ACT?
Acceptance and Commitment Therapy (ACT) is a form of talk therapy suitable for the treatment of individuals displaying symptoms of depression. As its name suggests, it’s core aims are to help individuals accept whatever is beyond their control, and to commit to actions or habits that will serve to enrich their quality of life. ACT helps us to clarify what is genuinely important to us (i.e our values), and thus assists us to set more meaningful and life-enriching goals. Along the way, it also guides us to practise useful emotion-coping strategies such as mindfulness in order to equip us with skills to handle negative emotions effectively and healthily. While the number of ACT sessions may differ for each individual, the benefits acquired by clients are largely similar:
Learning to be fully present in the “here-and-now”, and to stop obsessive worrying over the past or future
Become aware of what they are avoiding (be it consciously or subconsciously), and to increase self-awareness
Learning to enjoy greater balance and emotional stability, and to be less upset by unpleasant experiences
Learning to observe thoughts such that one does not feel held captive by them, and to develop openness
To develop self-acceptance and self-compassion
Clarifying one’s personal values and taking the appropriate action towards his goals.
You may be wondering, does it really work? The good news is that ACT is considered to be an empirically validated treatment by the American Psychological Association (APA). Through program evaluation data, research has also shown that Veterans who completed ACT treatment phases displayed a significant decrease in depression in addition to improved self-awareness and a better quality of life.
What is DBT?
Apart from ACT, another alternative for the treatment of depression is Dialectical Behaviour Therapy (DBT). While originally used for the treatment of Borderline Personality Disorder, DBT has since been adapted to treat other mental health conditions including depression, anxiety, and post-traumatic stress disorder. A type of cognitive behavioural therapy, DBT aims to help individuals who struggle with emotional-regulation and are exhibiting maladaptive or self-destructing behaviours. It is not an uncommon sight for persons with depression to engage in substance-abuse or self-harm. As such, DBT helps to build on distress tolerance, such that people who struggle with these are able to handle negative life-circumstances better and to avoid falling back on such devastating coping methods.
DBT can be considered a holistic approach to depression treatment. Apart from tackling maladaptive behaviours, it encourages a shift in the clients’ perspective on life, for it equips them with the necessary skills to cope with intense emotions. In short, it empowers you to cope with them with a positive outlook. DBT also recognises that interpersonal effectiveness is key, and hence it strives to help these troubled individuals to reconnect and enhance their relationships with others.
ACT Versus DBT
ACT and DBT are both highly effective methods of treatment for depression. Both forms of psychotherapy allow for individuals to tackle the notion of suffering head-on, and to avoid suppressing undesirable or uncomfortable feelings. Both promote psychological flexibility, and encourage people to behave in a conscious or effective way towards their life-choosing directions. The practice of mindfulness is also a commonality between both therapy methods, and it plays a crucial role in ensuring that persons are well aware of their values, goals and emotions.
However, overlaps between the two are considerably limited too. The main differences between ACT and DBT would be that DBT leans towards a more educative approach while ACT emphasises an experiential one. Perspective wise, DBT adopts a biosocial perspective on behaviour while that of ACT is contextual. Moreover, the underlying philosophy behind each form of therapy also differs. DBT philosophy is dialectical (i.e using logical reasoning and analysis), while the philosophy behind ACT is functional contextualism. With that said, the analysis of clients’ experiences, the use of languages as well as experiential exercises will be different for each type of therapy.
Caregivers with a family member affected by addiction problems are often exhausted, drained dry of their empathy and compassionate capacities.
They recount countless cycles of suspended hope followed by just as many broken promises as they watch the affected person return time and again to their compulsive addiction despite a seemingly obvious trail of destruction behind them.
Caregivers learn to cope with the endless demands on their energies by blending the words uttered by the affected persons as a cocktail of lies, manipulation and attention-seeking antics to get what they want.In time, the cries for help from the affected person turn into cries for help by the boy who cried wolf and eventually fading into indistinguishable white noise.
Professor Lisa Firestone of the Glendon Association observes that there is a natural tendency for caregivers to minimise any suicide expressions in general.Responses such as, “Well, his past attempts weren’t serious.” or “He is just manipulating to get something.” are commonly observed.There is also a general tendency to not want the expressions to be true.In the case of addicts, words such as “I want to die” or “I am going to end my life” no longer convey the same meaning or gravity of their sense of desperation.
Why should we want to pay attention to an addict’s cry for help?
In Singapore, we lose 1.1 lives every day to suicide.It is still the leading cause of death for youths aged 10 to 29.While direct correlation evidence is still being researched on, studies in America have shown that more than 90% of people who kill themselves suffer from depression have a substance abuse disorder or both. Suicidality and addiction share a high concordance relationship.
When we overlay the statistics with a physiological lens, we note that both groups of persons have been observed in studies to have a dysfunctional hypothalamic-pituitary-adrenal (HPA) axis which essentially controls our body’s response to stress.
In a person with a normal functioning HPA axis, on the reception of a stressor, the hypothalamus in our brain instructs the secretion of the corticotropin-releasing factor (CRF) and vasopressin to stimulate our pituitary glands to produce the adrenocorticotropic hormone (ACTH).The ACTH, in turn, stimulates glucocorticoid synthesis and release (commonly referred to as cortisol) from the adrenal glands.This chain reaction provides a person the increased energy to handle the stress event and to do so without suffering from the pain and fatigue.When the stress event is gone, the body produces a negative feedback loop which then brings the body system back to homeostasis.
In a person exposed to a persistent or extreme level of stress, or in a person who frequently activates the HPA axis through substance use, the body starts to blunt the sensitivity of the HPA axis and blunt cell receptivity to cortisol in its efforts to return to and maintain homeostasis.This alteration to the sensitivity of the HPA axis affects our ability to tolerate physical and mental stresses and creates a need for a much bigger stimulus to activate the HPA axis (which may mean higher dosage of substance use); and when the HPA axis does react, produces a much bigger and exaggerated response (which may translate to more aggressive behaviours).
What Does This Mean In Practical Terms?
Many suicidal persons described having a voice in their head which is constantly there; telling them how much they need to seek fulfilment and comfort by reaching for the desired stimulus, whether it be a substance or a behaviour, of which one is killing themselves.Their mind starts to command them to constantly plan, to seek out and to take actions to soothe the unbearable lack that they are feeling.Eventually, the voice in the head goes from coaxing and persuading to being more intensive and aggressive towards the self to take immediate drastic actions.
The relief of death, a final refuge, becomes alluring and pleasurable and the fear of dying eventually transforms into the fear of not dying and becoming the loser, disappointment, and burden that they already believe themselves to be to their caregivers.This dual push towards drastic action and the need for an ever-increasing amount of substance in addicts leads to an increase in the risk level of suicidality.
What Can We Look Out For?
How then does the caregiver separate the wheat from the chaff amid the chaos that addiction has already wrought onto the family system to detect the risks of suicidality?
Below are some, though not exclusive, common markers to look out for. It is particularly useful to note changes in the content of the affected person’s expressions and any escalation or sudden extinction of intensity.
Intense Emotional Outbursts
Extreme Isolation or Withdrawal
The feeling of Being a Misfit in Every Way
Researching or Procuring Means of Suicide.
Self-Harm, Including Risky Substance Use or Behaviours.
Planning of Affairs.
Presence of Trigger Events
Loss of Primary Relationship.
Physical or Mental Health Conditions That Debilitate.
Abuse or Trauma Events.
What Can Caregivers Do On Observing The Signs?
Ask the Suicide Questions:
In the past few weeks, have you ever wished that you were dead?
In the past few weeks, have you felt that you or your family would be better off if you were dead?
In the past week, have you made plans about killing yourself?
Have you tried to kill yourself?
If the answers are yes to any or to all the questions, caregivers are encouraged to take the following first steps:
Be empathetic towards the suicidal wish.
The objective is not to agree with the act of suicide but to understand what has happened to lead the affected person to the conclusion that suicide is the only solution.
Find a genuine connection with the affected person.
However difficult that person might have been in your life, express what this person means to you personally and how the loss of this person would affect you.
Make a safety plan.
Ask the affected person to agree to not take or delay any action to harm themselves until they get to or you get them to professional help.
Professor Lisa Firestone observes that suicidal persons are generally ambivalent: a part of them wants to die but a part of them wants to live as well.There is often a process of the dividing up of the self within the person, between an aspect which is life affirming and engaging with the outer world; and the anti-self, which is self-critical, self-hating and ultimately suicidal.The key to recovery is to connect with and help strengthen that part of them that wants to keep on living.
6 Dazzi, T., Gribble, R., Wessely, S., & Fear, N. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361-3363. doi:10.1017/S0033291714001299
We are no strangers to feelings of anxiety – at certain stages of our lives or in particular situations, we would have experienced anxiousness and worry with relation to our careers, studies, relationships and even our environment. However, anxiety levels may go beyond the healthy norm for some people, and may instead develop into anxiety disorders that may have a debilitating effect on their lives. According to the American Psychology Association (APA), an individual who suffers from an anxiety disorder is described to have “recurring intrusive thoughts or concerns”, where the duration and severity in which the individual experiences anxiety could be blown out of proportion to the original stressor, resulting in undesirable tension and other physical alterations. In this article, we will be exploring a few types of anxiety disorders as well as how they can manifest within us.
Generalised Anxiety Disorder (GAD)
Generalised Anxiety Disorder is a psychological issue characterised by persistent and pervasive feelings of anxiety without any known external cause. People who are diagnosed with GAD tend to feel anxious on most days for at least six months, and could be plagued by worry over several factors such as social interactions, personal health and wellbeing, and their everyday routine tasks. For example, an individual with GAD may find himself experiencing headaches, cold sweats, increased irritability and frequent feelings of “free-floating” anxiety. Others may also experience muscle tension, sleep disruptions or having difficulty concentrating. Often, the sense of anxiety may seemingly come from nowhere and last for long periods of time, therefore interfering with daily activities and various life circumstances.
In contrast, Panic Disorders are characterised by the random occurrence of panic attacks that have no obvious connection with events that are co-occurring in the person’s present experience. This means that panic attacks could occur at any time, even when someone is casually enjoying a meal. Of course, panic attacks could also be brought on by a particular trigger in the environment, such as a much-feared object or situation. Some individuals have reported that panic attacks feel frighteningly similar to a heart attack, especially with the rapid increase in heart palpitations, and the accompanying shortness of breath. Other symptoms also include trembling, sweating, and feelings of being out of control. With these panic attacks bringing on sudden periods of intense fear and anxiety, it can be exceptionally terrifying when these attacks reach their peak within mere minutes. However, a notable difference between a panic disorder and GAD is that an individual diagnosed with panic disorder is usually free of anxiety in between panic attacks.
Obsessive-Compulsive Disorder is a disorder marked by patterns of persistent and unwanted thoughts and behaviours. Obsessions are recurrent thoughts, urges or mental images that cause anxiety. On the other hand, compulsions are the repetitive behaviours that a person feels the urge to do in response to an obsessive thought or image. One common example often exhibited in films is where an individual has an obsessive fear of germs. This person may avoid shaking hands with strangers, avoid using public restrooms or feel the urge to wash their hands way too frequently. However, OCD isn’t purely limited to feelings of anxiety due to germs. OCD can manifest in other ways as well, such as wanting things to be symmetrical or in perfect order, repeatedly checking on things (“Did I leave my stove on?”), or the compulsive counting of objects or possessions. While everyone double-checks their things and has their own habits, people with OCD generally cannot control their thoughts and behaviours, even if they are recognised to be rather excessive. They can spend at least 1 hour a day on these thoughts and behaviours, and will only feel the much-needed brief sense of relief from their anxiety when they perform their rituals. As such, OCD can be exceptionally debilitating to one’s mental health.
Social Anxiety Disorder
Persons with Social Anxiety Disorder, or SAD, experience high levels of anxiety and fear under particular or all social situations, depending on the severity of their condition. They are often afraid of being subjected to judgement, humiliation or rejection in public, causing them to feel embarrassed. As such, individuals with SAD may feel extra self-conscious and stressed out, and try to avoid social situations where they might be placed at the centre of attention.
A phobia involves a pathological fear of a specific object or a situation. This means that one may experience intense anxiety upon encountering their fears and will take active steps to avoid the feared object. Phobias may centre on heights(acrophobia), birds (ornithophobia), crowds and open spaces(agoraphobia), and many others. People with agoraphobia, in particular, may struggle to be themselves in public spaces, for they think that it would be difficult to leave in the event they have panic-like reactions or other embarrassing symptoms. In severe cases, agoraphobia can cause one to be housebound.
The anonymous author of this article is a person in the recovery of Major Depressive Disorder and Borderline Personality Disorder. The views of the author are not those of Promises.
I have struggled with Self-Harm since I was a kid. Most of us are aware of the tantrum’s kids put up when they are upset. They hit others, drop to the floor, scream, and cry. When I felt overwhelmed by certain emotions, in particular anger or sadness, I would use my hands to hit my head. I had trouble identifying and regulating my emotions. My primary school counsellor told me that I have anger management challenges when I shared with her how I find myself unable to control my anger and would hit myself or the well. Little did I know that these behaviours were early signs and symptoms to what would become a diagnosis of Major Depressive Disorder and Borderline Personality Disorder given to me in my 20s.
When the word ‘Self-Harm’ is mentioned, most people think about ‘cutting’. A very common and increasingly concerning the mode of coping for persons in distress, more so for young people, even children. Fortunately, I never turned to ‘cutting’ until I was 23. I was actively suicidal from the stress of battling my illness while also trying to excel in my degree. I began with a penknife and one cut. Soon, that one cut led to many and I found myself with a new problem.
I struggle with Self-Harm till this very day; however, I have come a long way with the help of medications and therapy to reduce the frequency of Self-Harm. I have been trying to replace Self-Harm with healthier coping methods such as exercise.
When I do not wear long sleeves, I end up exposing the scars on my wrists to the world. Generally, I tend to feel ashamed of my scars and it took me some time to embrace them. However, responses from others who have noticed my scars have caused discouragement to me and led me to feel ashamed once again. Ironically, this does not deter me from ‘cutting’; instead, it increases the urge because I develop self-hatred and feel like I deserve to be punished and scarred for my behaviour.
Through this sharing of my experience, I hope to send a message of love to peers who are challenged with Self-Harm, whatever form it might take on. I also want to raise awareness among members of the public on what were some unhelpful words and behaviours people have made towards me, more so out of a lack of awareness rather than a lack of concern. I have learnt to forgive them, and at times have also made the effort to voice my discomfort over their words and actions. Here are five things people have said or done to me that were completely unhelpful, and very likely also to be unhelpful to anyone else challenged with Self-Harm.
1. Touching me without permission I get it, you notice the scars and you get worried. Without thinking, you grab my arm and go “what is this? Did you cut yourself?”. Leaving the question for later, the very act of grabbing my arm to look at my scars without permission is a big ‘NO’. I am hypersensitive to my scars and it takes much courage for me, even till today, to deliberately lift my arm to show my scars. What may surprise you is that, often, this act comes largely from my own parents and also the professionals I see for help. It is good practice to always ask someone for permission if you wish to touch them, even if it means to give a hug. Because some of us who have challenges with trauma and dissociation are hypersensitive to touch. Hence, do be mindful of those around you and remember: If you do not like people grabbing you to see something (on you), it’s the same and perhaps even more, for those of us learning to accept our scars.
2. “Doesn’t it hurt?” No, it doesn’t. This answer may come as a surprise to many, but when I am under extreme stress and emotional distress, the act of physically inflicting hurt on myself gives me relief. The greater the physical “pain” the greater the relief. For me, this goes for any act of self-harm be it ‘cutting’, punching the wall, or knocking my head against the wall until it starts bleeding. I can only compare this to someone who meets with an accident. The body goes into shock to the point the person may have a broken leg; however, he or she is not feeling any pain. I do not have a formal education in psychology or biology, but I believe my brain “shuts down” the part that feels pain which aids me to self-harm without feeling the actual pain.
3. “The scars are so ugly! Why do you enjoy this? Can’t you stop?” This is a three-part question, but it often comes to me in one line of questioning. First, I want to say that I do not enjoy this. Not at all. I would love to have clear and beautiful skin too. Every time I look down at my arm to see the scars, I feel hatred towards myself. “How could I do this to myself? I am a horrible person”. And yet, I find that I cannot stop. A coping method I have turned to, since childhood, to cope with the traumatic experiences and intense emotions is self-harm. It has become the default and almost automatic ‘subconscious’ act whenever I am in distress.
4. “It doesn’t look too bad” I know that this statement is in direct contrast to the one above. But I have had this said to me by peers and sadly, professionals. There is not much need for me to elaborate on this statement as it is obvious that it is unhelpful. This statement makes me feel like a failure and makes me want to hurt myself even more. The ‘Depression voice’ is always on standby, ready to jump in with a “See, you are useless at even trying to hurt yourself? You call that a cut?! You are a coward. Go and do it again”.
5. Taking away or hide the sharp items that I could use to hurt myself This is probably most relatable to parents and caregivers supporting someone who is challenged with self-harm. It is very natural to become protective and do what it takes to stop your loved one from hurting themselves. “If I take away their means to hurt themselves, then they have no choice but to stop, right?” Unless you tag along with your loved one 24/7, it is very easy to drop by the nearest bookstore to buy a new penknife. More importantly, in doing so, you are taking away the one thing that I have which keeps me from jumping out of my window or overdosing on my pills. Until I learn to safely stop self-harming in therapy, to take it away from me by force, will throw me into an emotional turmoil that will only make me feel worse.
So please, next time you notice someone with scars that look like they might be from the act of cutting one-self, please be gentle and kind to the person. Be extremely mindful of what you say. Perhaps, a guiding thought could be: If you cannot entertain the idea of causing pain to yourself, imagine how much pain the person must be in to be able to cause harm to themselves. When I self-harm, it is a desperate means for me to stay alive. It is a cry for help: for attention, for love, care and non-judgemental support.
If you know a loved one who self harms please do gently prod him/her towards seeking help from a trained professional.