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The Royal College of Psychiatrists Improving the lives of people with mental illness

A unique branch of medicine


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In a very basic way, doctors working in mental health use much the same skills as those working in other areas. Medical school always felt like a challenge in which you cram your head with as much information as you can and hope to hold onto enough of it for long enough to get through your exams. When I started working, I realised that for 5 years they had been teaching me a system or a strategy for managing sick people in a (largely) foolproof way. When you leave medical school you have a highly systematic method for quickly assessing the patient, rapidly identifying which one of the thousands of things you have learnt about is going wrong in front of you, focusing on the dangers associated with that particular problem and quickly devising an efficient plan to deal with what you’re seeing.

It may not always be as obvious, but a structured approach and absolute precision are as important in mental health as in any other specialty. The difference lies in the knowledge base that we work from. Neurobiology and the pathophysiology of mental illness is an important part of this knowledge base. The same principles apply here as in any other area of medicine. There are, however, a number of differences. The first is that our understanding of the pathophysiology of mental illness is more limited than in many other areas of medicine. The second difference is that neurobiology is only one of a number of different ways that we have come to conceptualise mental illness. We also recognise that the mental wellbeing or otherwise of the individual is linked to their life experiences. Their development and experiences through childhood and beyond can be a significant factor in the development of mental illness. More current circumstances and life events can also contribute to the development of mental illness. The theories and knowledge base that underpin this aspect of our understanding are as complex and important as the neurobiology of mental illness. The treatment of these kinds of problems is also much less straightforward than writing a prescription.

Treating the whole patient

The biological, psychological and social aspects of each individual case need to be carefully considered and attended to in thinking about management. This is a considerable challenge and the reality is that you could happily devote your whole career to fully understanding just one aspect of the model. It is no simple task to develop a full and workable model to guide your practice. Our capacity to utilise these models to understand the people that we work with is technically important. It is also often the case that the sense of being understood is one of the most powerful interventions that we can offer to the people with whom we work. In psychiatry, our relationship with our patients is often as important as any technical intervention that we can provide. Mental illnesses are often considered to be less “serious” than physical illnesses. The reality is that the morbidity associated with mental illness tops most charts comparing the specialties. Mortality is not insignificant and never inconsequential. Death by suicide is always tragic and has massive implications for friends and family. 

Psychiatry is complex, challenging and absorbing

Working in psychiatry you still use the core skills that you develop as a medical student and a doctor. It is complex, challenging and absorbing. The big draw of psychiatry is that you have the freedom to make what you want of it. You can choose to specialise in any of numerous subspecialties. Within your specialty, you can choose to work in a way that bests suits your personality and how you think about psychiatry. It is this variety, flexibility and freedom that make it such an interesting area to work. I have always enjoyed my work and found it extremely satisfying. It’s also true that time spent with the patients is often much more fun than work really ought to be.  

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