Are bad times good for psychiatrists?

Life seems stressful these days. With the current economic crisis and impending national election, there is a sense of instability in the air. Many Americans have seen their retirement investments dwindle, many others cannot find car or home loans. Most of us wonder what the future will hold.

Acquaintances occasionally ask me if this situation is “good for business.” Do stressful current events lead more people to seek psychiatric help?

At least in the case of economic downturns, apparently not. A recent Wall Street Journal MarketWatch article says that mental health visits decrease in bad economic times, with unfortunate results for patients. But how about seeing a psychiatrist to cope with other stressful events?

In my experience, people either seek my help for internal issues unrelated to current events, or for a repeated pattern of over-reaction to such events — basically, something about them, not the situation. The only common exception is the death of a loved one.

This focus on changing oneself differentiates psychiatry from counseling or “coaching.” Career counselors and life coaches help clients deal with life challenges, without attempting to change the client’s personality or coping skills in any fundamental way. Talking things over with friends or family is similar: You are who you are, the problem is the situation and how to deal with it.

Tranquilizers, too, can help a person deal with stress without changing the person in any fundamental way. Tranquilizers are prescribed mostly by primary-care doctors like internists, family practitioners, and Ob-Gyns. They are best used only occasionally and for short periods of time (days not weeks). Psychiatrists also prescribe tranquilizers, although rarely as the main treatment for a patient’s problems.

Psychotherapy, conducted by a psychiatrist, psychologist, or other mental health professional, aims for more than this. While we can’t do anything about the stock market, we can help clients cope better with stress when it does arise. This is akin to the old saying, “Give a man a fish and he eats for a day. Teach him to fish and he eats for a lifetime.” In addition, psychiatrists are medical doctors who can diagnose and treat conditions, like major depression, that impair coping across the board. Whether the psychiatric treatment consists of medications, psychotherapy, or both, the focus is on the patient, not the stressful situation.

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