go into Psychiatry?
By John Tennison, M.D. and Psychiatrist (A.K.A. Nonjohn)
answer the question of "Why go into psychiatry?," it is helpful to
first answer the question of "Why go to medical school?"
Of course, the easiest answer to this question is, "because medical
school completion is required to gain admission to a psychiatric
residency!" In fact Solomon
Snyder, a brilliant scientist, psychiatrist, and chairman of the Department of
Neurosciences at Johns Hopkins wrote, "In college I was far better at
writing and philosophy than at science, but like many of my friends, I chose to
pursue a premedical major; philosophy is hardly a proper vocation for a nice
Jewish boy. Although I did not
particularly look forward to medical school, I did see it as a vehicle to gain
admission to psychiatric residency training, and that is where I had set my
sights. In medical school, I eagerly absorbed everything my books and teachers
could tell me about the brain, but I approached the rest of my courses
perfunctorily at best. One other subject did catch my fancy, however, and that
was pharmacology. I found it incredible that simple chemical molecules could
bring about such profound changes in the human body, and I was intrigued by the
disparity between how drugs were used and what was actually known about them:
drugs have long been the primary means of treating most diseases, yet until
recently physicians have had little understanding of how most pharmacological
agents exerted their therapeutic effects. Needless to say, any drug that
affected the brain struck me as being especially interesting."
(from Drugs and the Brain, Scientific American Library, 1986)
addition to Snyder's justification for attending medical school, it makes sense
to consider what benefits medical school offers over and beyond being a
necessary pathway to psychiatric training.
Depending on the values of who you ask, you will invariably get a
multitude of answers to this question. For
example, if your passion is for general clinical medicine, you might very well
find all of the traditional medical-school curriculum to be interesting.
However, if you are driven more by timeless philosophical questions
regarding existential issues, mind-body relationships, ultimate truth, etc., you
might see the required memorization and dehumanizing workload of medical school
to be necessary evils on the way to getting at the people, places, things, or
ideas that truly interest you. For
those with such broad interests, the most desirable medical schools will be
those that have the most flexible curriculums, the fewest required courses, and
that encourage you to think for yourself, rather than use you as a grunt to get
work done. Moreover, it is best to
attend a medical school with as many classes AND clinical rotations graded on a
pass/fail basis as possible. In
doing so, you will avoid putting yourself in a position of feeling pressured to
OVER-memorize minutia that has virtually no value to you or your patients.
(Don't worry -- even medical schools with pass/fail grading are
"standardized" enough to prepare you to pass the national USMLE boards
required for licensure in the United States.)
Thus, anyone with an interest in psychiatry should first ask themselves
if they are willing to enroll in medical school and complete a medical degree,
the activities of which will not always be intimately related to the issues that
typically fascinate psychiatrists.
Even if one did not go on to complete a psychiatry residency, a medical-school education by itself is among the best liberal-arts educations available from a single degree program within the United States. However, if a physician did not apply his or her medical education in ways that improved the human condition, a medical education would be a waste of resources. Moreover, a physician does not necessarily have to work within the traditional confines of clinical medicine or doctor-patient relationships to have a positive effect on humanity. Particularly in the United States and other places where the content of medical education is highly regulated, a medical school graduate will have built a classical, liberal-arts foundation that is immensely useful, regardless of one’s chosen endeavor. The perspective instilled by this educational background helps physicians to prioritize and see more clearly many of the most important challenges facing humanity, many of which are not within the realm of "disease" or "pathology."
The liberal arts value of a medical education can be further enhanced by attending a medical school that is part of a larger university that will let you take courses offered at the other non-medical schools that make up the university. Being enrolled at a medical school at a university offering an on-campus training hospital, extensive undergraduate and graduate degrees, a law school, a business school, and, if possible, other graduate/professional programs is optimal. There are some universities that have these resources spread over several campuses. However, the best arrangement is to have the time-saving convenience and inter-departmental collaboration that result from having all of these resources on a single campus. My word for such a campus is “geccun” – my acronym for “GEographically Consolidated Complete UNiversity.” There are several universities within the United States that are geccuns, including Stanford, UCLA, University of Chicago, and the University of Pennsylvania, to name a few.
address the question of why one would choose a psychiatric residency over
training in another medical specialty, it is helpful to examine the breadth of
issues that define psychiatry. It
is also helpful to compare psychiatry to two closely-related fields:
neurology and psychology. For
example, both psychiatrists and neurologists are interested in neuronal
processes. Consequently, the same
certifying board accredits both psychiatrists and neurologists.
However, psychiatrists more often focus their attention on neuronal
processes that have a bearing on the quality of someone’s experience over a
lifetime. For example, a
psychiatrist tends to be less interested than a neurologist in the behavior of a
neuron in someone’s big toe, unless that neuron is doing something that
impinges on experience, such as causing pain.
Thus, a psychiatrist can be thought of as a psychologically-minded
neurologist, someone who is especially concerned with neuronal processes that
have a strong bearing on how you feel, think, and behave.
In addition to emphasizing neuronal processes that influence subjective
experience, psychiatry residencies are distinguished from neurology residencies
by requiring psychiatry residents to undergo training in five forms of
psychotherapy. It is in this area
that psychiatry has overlap with psychology.
The emphasis on psychotherapy recognizes the fact that many things other
than neuronal processes contribute to mental health.
A good psychiatrist eclectically seeks to learn all factors than
impinge on a person’s mental health, including social, environmental,
cultural, political, and religious influences.
Psychiatrists are legally empowered to use all treatment and assessment
modalities available to psychologists, including psychological testing.
However, psychiatrists also have expertise in human physiology,
pharmacology, and licensure to prescribe medication.
Thus, given their medical-school background, a psychiatrist could
be thought of as a physiologically-trained psychologist.
Whereas some medical specialties are only now beginning to emphasize
spirituality and creativity in their practices, psychiatrists have been doing so
for many years. The work of
psychiatrist Carl Jung exemplifies psychiatry’s strong historical emphasis on
spirituality and creativity.
Ideas from psychiatry have considerably influenced our culture and the
media, and provided subject matter for some of the greatest films, music,
literature, and art ever produced. Ron
Howard’s Academy-Award-Winning Best Picture, “A Beautiful Mind,”
demonstrates how fascinating, and yet tragic, mental illness can be.
HBO’s “The Sopranos” portrays an entertaining account of what
psychotherapy for a Mafia boss might look like.
The word, “psychedelic,” was coined by psychiatrist, Humphrey Osmond,
and has been used by many to describe musical, visual, cultural, and political
movements that emerged in the 1960s and continue to this day.
Psychiatrists are interested in far more than mental illness.
Consequently, psychiatrists do far more than treat mental illness alone.
There are currently seven board-certifiable subspecializations within
(Mind-Body) Medicine, Clinical Neurophysiology, Pain Management, Forensic
Psychiatry, Child and Adolescent Psychiatry, Addiction Psychiatry, and Geriatric
subspecializations of psychiatry include Sports Psychiatry, Preventive
Psychiatry, and Transpersonal Psychiatry.
psychiatrists are well-grounded in science, as evidenced by psychiatrist Eric
Kandell having won the Nobel Prize in 2001.
For example, the Research Imaging Center at the University of Texas
Health Science Center in San Antonio is a world-class facility where psychiatry
faculty image human brains in research that could revolutionize our
understanding of the human mind.
careers focusing on subjective human experiences or social interactions,
completing a psychiatry residency builds further upon the liberal-arts
foundation of a medical-school education. For
example, the ability to see through duplicitousness is a skill developed during
psychiatry residency training. This
skill has been extremely useful for Jim
McDermott, the psychiatrist in congress who contributed his astute
commentary and insights to Michael Moore's "Fahrenheit 9/11," to date
the highest grossing documentary of all time. Other physicians apply the liberal-arts foundation of a medical education
to the arts, as evidenced Michael
Crichton’s numerous novels and screenplays for television programs and
movies. Still another example comes
from psychiatrist Fred Goodwin's excellent radio program, "The Infinite
Mind," as heard on National Public Radio.
Goodwin’s program provides fascinating insights that do not necessarily
focus on “pathology,” yet always help us to better understand the human
Psychiatry has more in common with the formal discipline of philosophy than any other medical specialty. For example, Louis O. Kattsoff wrote that philosophy “examines the foundations of other studies. It asks the social scientist what he believes to be the nature of man. It asks the physical scientist why he uses the scientific method. Philosophy seeks to organize the results of the various sciences to show the many ways in which they are related.” In a similar vein, Henry Sidgwick has noted, “It is the primary aim of philosophy to unify completely all departments of rational thought.” Consequently, because of its eclecticism, psychiatry is easily the most "philosophical" of all medical specialties. Put another way, psychiatry exists where medicine and philosophy intersect.
Another strong connection that psychiatry has to philosophy is in determining what to label as “psychotic” or “delusional.” Psychiatrists make daily practical application of philosophy by asking the timeless ontological questions of “what is real?,” “what is not real?,” “what exists?,” “what does not exist?,” and “what are our criteria for determining whether or not we regard something as ‘real’ or having ‘existence’?,” etc. The way psychiatrists articulate answers to these questions has substantial affects on the attitudes and value judgments that society makes about patients who are having unusual experiences or who make unusual claims. This ontological role of psychiatrists can potentially be harmful if psychiatrists are not extremely careful in what they label as “psychotic” or “delusional.” For example, imagine if the Wright Brothers – after claiming they would achieve human flight – had been locked away in a psychiatric hospital as a result of a psychiatrist believing the Wright Brothers were a danger to themselves and/or others. Clearly, psychiatrists have a great responsibility to exercise caution, sensitivity, precision, and empathy when dealing with ontological issues.
visited and spoken with residents and faculty across the nation from Harvard to
Stanford, I have come to believe San Antonio has one of the best psychiatry
residencies in the country. Moreover,
I regard San Antonio as one of the best places to live in the United States.
If you are a physician, I hope you will consider psychiatry as your
medical specialty. I encourage
anyone considering psychiatry as a career to speak with residents at the
University of Texas Health Science Center in San Antonio.
I invite you to email me any time at firstname.lastname@example.org
so that I may share my enthusiasm for psychiatry, the
most fascinating and profound of all medical specialties.
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