5 Things You May Not Know About Psychiatry*

Maybe you’re well-read, and Sylvia Plath and Ken Kesey are your homies. And you watched Prozac Nation and Black Swan and A Beautiful Mind and you didn’t laugh at the protagonists or roll your eyes at their “crazy”. So even if you haven’t rotated through Psych – or maybe you’re not even remotely in the medical field – your Psych knowledge is right up there. You’re not ignorant. Here are some things about twenty-first century psychiatry that might surprise you.

1. We don’t really do Freud anymore

Freud may have been a revolutionary of his time and profession, but psychologists and psychiatrists have for the most part moved on. Cognitive Behavioural Therapy and Motivational Interviewing are the latest fads. My experience is limited, but they seem to be doing well. We may or may not move on from them too, one day.

2. We don’t do straitjackets anymore

Of all the horrible things, I think this may have been most nightmare-inducing. Any psychiatric patient of previous centuries would have been able to tell you this, but straitjackets are uncomfortable and actually pretty dangerous. If a patient falls, he/she cannot break the fall. Instead they break ribs. Or they dislocate a shoulder while struggling. This, coupled with arms wrapped tightly across one’s body, is inclined to reduce inspiratory capacity and respiratory depression is unwanted even more in a patient who may already be on sedatives.

3. We don’t do padded rooms anymore…

What, really?! It seems we have finally realised that the patient who seriously wants to harm himself tends to find a way. Padded rooms prevented head-bashing, but people started dislodging the padding and stuffing it down their throats. Nowadays we use isolation rooms coupled with the appropriate medical and psychotherapy when a patient is a danger to himself or others.

4. … but sometimes we do use restraints

In private settings, psychiatrists can use these amazing elastic restraints for aggressive patients (not every patient needs to be restrained, you know). Unfortunately they are really expensive and single-use. So in public sectors we still sometimes see inventive uses of bandages when a patient is out of control. It sucks. But in a hospital-setting, there are often more than just the patient’s life at risk.

5. Extra: We’re not pill-pushing

This one is more open to debate and more likely to find disagreement. Advances in science have proven that mental illness is not separate from the body – we know that biochemistry plays a big role, and that the brain undergoes physical changes during such illness. We would never tell a diabetic patient to stop taking their insulin and simply talk or pray through it, would we? But we should always be mindful of the psychosocial aspect of the patient’s life, and be aware of non-medical approaches to an illness.

*Brought to you by my current psychiatry rotation. This information is true for South Africa and may vary in other countries.

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