It is quite common for people to confuse psychology and psychiatry, psychological issues with psychiatric issues, and psychologists with psychiatrists. Many people mistakenly believe that the two are one and the same thing, others may be struggling with a mental health issue and not know whether to turn to a psychologist or a psychiatrist. In this article I hope to not only help clarify the distinction, but also express the importance in understanding that distinction if and when you or someone you know feels they need mental health support.
Put in basic terms, psychology is focused on human behaviour, and the underlying cause of that behaviour in terms of experience, trauma, emotions or belief systems, and applies a therapy based treatment. Psychologists cannot prescribe drugs. Psychiatry, on the other hand, is focused on neurochemistry and any brain chemical imbalance that may be causing symptoms and will, if necessary, lead to prescription of drugs to stabilise that chemical imbalance.
If you feel that you need support with mental health, your first step could be to see a GP, who should then refer you to the mental health team, who should then, after assessing you, decide whether what you personally need is a psychological approach or a psychiatric approach. Usually this decision is based on the type and severity of your symptoms; if those symptoms are so overwhelming that they are potentially immediately destructive to you or someone else, or seemingly triggered by a chemical imbalance that therapy will not get to the root of, you may be referred to a psychiatrist for treatment and be prescribed drugs. However, if those symptoms are milder, albeit very hard to cope with, and do not hugely interfere with your life and seem to stem from outside experience, you may be referred to a psychologist to undergo a term of therapy. Please note, however, I am not a medical practitioner so if the above does not apply to you, this is just a general outline of how the system works.
If you are unsure who to turn to, however, and all you know is you need medical intervention of some sort right now, do no hesitate to turn to any of the above specialists immediately; a trained professional should be able to listen to you and steer you in the right direction even if you initially went to the wrong doctor for you.
This is, like I say, how it should work. Put simply, it looks like a system that would be effective and efficient to treat mental health issues. Unfortunately though it is not always easy for doctors to accurately identify or diagnose mental health conditions because, as with all invisible illnesses, all they have to go by is what you tell them (they are unable to test you or check you physically for specific conditions), and too often drugs are prescribed unnecessarily when therapy would have been sufficient. More distressingly, those unnecessary drugs sometimes trigger catastrophic side effects and massively compound the problem. Again, I am not a doctor, and cannot advise anybody to choose therapy over prescribed drugs. All I can do is share my own experience with this system and how it can go wrong and hope it raises some awareness of the caution that should be taken.
In a nutshell (because it is now such a long and convoluted story that could have potentially ended a decade ago with a course of therapy), when I was in my early 20s I felt overwhelming anxiety about pretty much everything. This sense of inundation and doom moved me to see a GP. It is to be noted that this GP did not even refer me to the mental health team, but rather took it up himself to prescribe a drug called Seroxat. As we tend to do, I put my trust in a medical professional, and took the drug. After a couple of months, I went back and told this same GP that I felt like I was losing touch with reality because I was finding it increasingly hard to focus or control my behaviour, so he doubled the dose. The result was my first psychotic episode that saw me run away, spend 24 hours walking around Gatwick Airport booking flights and not getting on them, and eventually being escorted out of the departure lounge. I was taken to see a psychiatrist in London who mistakenly diagnosed me with bipolar disorder based on those symptoms he was seeing. Those were not symptoms of “ME”; they were a horrific side effect of Seroxat. Had I just been taken off that drug at this point, this is where the story would end. I was taken off it, but it was replaced with Lithium and Lamictal, drugs to treat bipolar disorder. As hard as it is to believe, I then spent about ten years continuing to have psychotic episodes and mood swings, which were taken by psychiatrists to be further evidence of my diagnosis, and having doses not only increased but, as the years went by and still having pschotic episodes, the drugs changed for others to find the ones that would work.
None worked. Why? Because the drugs were the problem; the drugs themselves, in my case, were triggering the psychotic episodes the whole time. I spent ten years, however, convinced I had bipolar disorder because the psychiatrists said so, and believed I must have such a severe case that, despite drugs, I was still having episodes. It was not until four years ago, having lost my 20s to chaos, that I became totally desperate and pleaded at a local psychiatrist to help me because I was at the end of my rope. The initial point of my visit was to say if the drugs aren't working then please just take me off them. Little did I know that this is what I should have done years earlier. Had she taken this course of action, because ultimately it was up to me whether or not I took those drugs, the end result would have been the same and a shock: I am way better now without them. But this psychiatrist actually spent about two hours looking over my entire case history and asked me the only question no other psychiatrist had thought to ask me the entire time: “Had you ever had a psychotic episode before being put on any of these drugs?” And of course the answer was no.
It now seems so obvious it’s mildly embarrassing that I did not think of this myself years earlier. Up until I took Seroxat, I had experienced various anxiety issues, yes. But I had never been psychotic. I will never forget the moment that this psychiatrist, after ten years of chaos, leaned back in her chair, threw her pen on the table, looked at me, sighed, and said “I don’t think you have bipolar disorder, I don’t think you should be on drugs at all.”
I think I stared at her for what felt like another decade. I felt mixed emotions of relief and anger at losing so much LIFE to something totally and utterly unnecessary. If she was right, which it turns out she was, I felt completely cheated and failed by a system I had trusted like so many others and suddenly terrified for the potentially huge number of people in the same position as me. I have no idea how often this happens, and I am in no way implying that you or anybody you know is on drugs when they should not be, or to stop taking them. But the point is that it evidently can happen. Due to how chaotic my life was, the psychiatrist made the call to remove all the drugs cold turkey rather than slowly reduce them. This was gruelling - cold turkey drug withdrawal is horrific and creates a profound sense of confusion and isolation while your brain chemistry tries to sort itself out. But after six months, my life finally came back, albeit slightly dented and scarred.
But if these scars and dents serve to raise awareness about this, I carry them with pride. I did resent what happened for a while, but that went away when I learnt to focus on how errors happen and I am one of the lucky ones who finally did get to the root of the problem, and I got there through therapy in the end. I should never have gone down the psychiatric route, and I do sometimes wonder how life would have panned out had I just taken the psychology/therapy route from the start, but there is no point dwelling because the past cannot be changed - all I can do is share this story so people know this can happen.
Be as aware of the difference between psychology and psychiatry as possible because, as you can see, it is important. I am no doctor and I cannot advise anybody on any course of action when it comes to mental health. I can only say: be aware.