APA vs. APA

Psychology vs. Psychiatry: What's the Difference, and Which Is Better?

Starts out, "Psychologists and psychiatrists tend to hate each other."

Metaphor or joke? Did this guy talk to even one representative of either profession? Is this just a wild extrapolation from his gross misinterpretation of the new APsychiatricA Guideline? Regardless, it's an opportunity for me and others to set the record straight.

Psychologists and psychiatrists not only should not, but do not, hate each other. In fact as fewer psychiatrists do psychotherapy we tend to refer our patients to psychologists for psychotherapy more than ever. Which reminds me of the biggest insult in this article, namely that the author seems to completely ignore the most numerous categories of psychotherapists and counselors, those who are neither psychologist nor psychiatrist, and who are, in my experience, often equally respected for their skills.

There is no "idea of psychiatry." Psychiatry is a profession, a medical subspecialty.  Psychology is a science. Clinical psychology is another profession. The first "chemical" treatment used on psychiatric patients was probably a group of drugs called mercurials which effectively treated neurosyphilis, leaving mostly patients with bipolar disorder and schizophrenia in the asylums. Morphine and barbiturates may have been the only chemicals available to help them at that time, and those drugs simply sedated them.

Contrary to what the author would have us believe, after Sigmund Freud (a neurologist) developed his very psychological theory of neurosis, psychiatry began to embrace talk therapy in the form of psychoanalysis, and circa the 1970's I believe psychologists had to sue to gain acceptance to psychoanalytic institutes that only admitted physicians. (I wonder whether the author realizes that the picture that accompanies the article portrays a "psychiatrist" -- not a psychologist -- psychoanalyzing a patient on a couch.)

So he thinks the Guideline "denigrates" CBT. Perhaps this best illustrates that such guidelines are just that, and are intended for trained professionals, not amateurs hoping to conjure up conflict where none exists. The real problem is that too many psychiatrists cling to psychoanalytic/psycho-dynamic methods. Those of us who restrict our practices to prescribing chemicals, however, regularly refer to psychologists, usually the real CBT experts.

The author accuses our leaders of acting like children for not relinquishing the acronyms APA, one organization to the other. Surely this must lead to confusion from time to time, but I have been blissfully unaware that anyone on either side ever wanted the other to change it's name. I wonder if the author would think the same of two SCCA's, the Seattle Cancer Care Alliance and the Sports Car Club of America.

I do agree with one statement: Combining medication with the right type of psychotherapy often works better than either alone. But "national guidelines that will shape the treatment of millions?" Most psychiatrists will not even read them, and those who do will probably keep practicing as they always have.

Which is better? Neither. Apples and oranges. They are just different.

I only have one (more) comment. Almost any psychologist or other psychotherapist could probably help John Cloud get in touch with reality and let go of his hatred for psychiatry.