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Differences between psychologists and psychiatrists

Dr Marcel de Roos is a Psychologist PhD from the Netherlands with a private practice in Colombo Sri Lanka.

Psychologists and psychiatrists are both mental health professionals who assess and treat (complex) mental disorders. A psychologist is an academic who has studied psychology and a psychiatrist is a medical doctor who is specialised in psychiatry. Psychiatrists work from the belief that mental disorders are biological in nature and try to treat the symptoms with medication. Psychologists assume that most mental disorders have a strong emotional, behavioural and cognitive component, look at the deeper and more comprehensive context and root causes, and treat these with psychotherapy.

Psychiatrists are trained to look for symptoms and subsequently label (“diagnose”) them according to a classification system. In the USA and in Sri Lanka this is usually the Diagnostic and Statistic Manual of mental disorders, fifth edition (DSM 5) while in Europe the International Classification of Diseases, tenth edition (ICD-10) is widely used. There are quite a few significant differences (for example with ADHD) between the two classification systems which signify the arbitrary nature of the classification. After a usual quick (5 – 10 minutes) symptom-focused interview a diagnosis is formed and a prescription for medication is handed over to the patient. 

Psychological assessment is quite different. Psychologists are also trained to diagnose and treat mental disorders but they focus on the root causes and the whole story behind the symptoms. In therapy the client learns to deal with the issues and finds emotional balance. Most mental health issues can and should be treated by psychological interventions. There are a few exceptions like (if correctly diagnosed!) bipolar depression and schizophrenia. Depression is a too serious and too complicated illness to be only treated with psychiatric medication. Medication can have its use for some time to make certain people with severe depression feel more stable, but a comprehensive psychotherapy focused on the root causes should be the mainstay.

The comparison between medical and psychological diagnostics is one with predominantly differences. What works well with symptoms related to physical illnesses doesn’t necessary goes with mental illnesses. Please read my next article “Do we need a diagnosis with mental health issues?” for a more detailed discussion.   

Psychiatrists and other medical doctors are generally speaking not trained in conducting and understanding research. Psychologists on the other hand, have to undergo a stringent and extensive schooling regarding research. Not only plain “statistics” like multiple regression analysis but more about the art of how to set up proper research studies and how to “read” them. Research is difficult; you need to have an extremely critical mindset. But in Sri Lanka the educational system (including universities) is more focused upon memorizing and reproducing than in critical thinking. As a consequence of all this, one often reads in the media unscientific and biased statements. For example the “chemical imbalance in the brain” regarding depression or the “serotonin reuptake” story (people are encouraged to believe that depression is caused by a deficiency of serotonin as in the analogy with diabetes and insulin); these are just clever marketing concoctions of the pharmaceutical industry without any scientific medical proof.

Psychologists and psychiatrists can work together but it’s a complicated relationship, mainly because of the above mentioned differences. Psychiatrists typically focus on trying to subdue the symptoms with medications which blunt the emotions while psychologists try to get to the bottom of the person’s emotional state. For psychologists medications usually are an interference with their therapies which aim to coach the person into a more emotional balanced state of mind. Also, psychiatrists may have heard or read something about cognitive behaviour therapy or interpersonal therapy but they often fail to understand the actual working mechanisms of psychological interventions, they typically lack the experience with those methods and they usually have no knowledge of psychological assessment.

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