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Expert Q&A

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Psychologist or psychiatrist -- which should I see?

Asked by PMacNeil, Albany, New York

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How do you know if you need a psychologist vs. a psychiatrist? When people say they have had a nervous breakdown, what is that? It isn't a specific diagnosis -- so how do they know what a nervous breakdown really is?

Expert Bio Picture

Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

I spent a fair amount of time thinking about your questions this week, because I've heard them many times before in various guises -- but I have never really had to give a clear answer.

Now, having thought about it, I realize that neither question has a clear answer. But that won't keep me from giving you my thoughts.

Psychiatrists are medical doctors who complete a residency after medical school. Psychologists are Ph.D.s who do a clinical internship after getting their degrees.

In practical terms, this means that psychiatrists tend to focus on diagnosing various mental disorders and then treating them with medications or other types of medical interventions. Psychologists use the same diagnostic system but usually treat patients with psychotherapy of one sort or other.

Psychiatrists often treat the most seriously ill patients, those with conditions like schizophrenia or bipolar disorder, while psychologists often take care of people with less severe mood and anxiety disorders.

I guess the most certain thing one can say in regard to whether someone would do better with a psychiatrist or psychologist is that if one wants medication treatment, a psychiatrist is the person you'd want to see.

I've always liked the phrase "nervous breakdown" because it captures something of how horrible an episode of serious mental illness can be. But, in fact, it really has no specific meaning, other than being an episode that is so severe that a person's life and functioning come grinding to a halt.

Some people who have nervous breakdowns are suffering from severe depression or anxiety. Others are having an initial episode of schizophrenia or mania.

These are very different conditions, with very different likely outcomes, that require different types of treatments.

So as a psychiatrist, when I'm evaluating someone who tells me they've had a nervous breakdown, this is only the beginning of what I need to learn in order to help the person.

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