Demystifying Psychiatry: A resource for patients and families

Washington University School of MedicineDec 15 2009

Psychiatric disorders are underdiagnosed, poorly treated and highly stigmatized, according to psychiatrists Charles F. Zorumski, M.D., and Eugene H. Rubin, M.D., Ph.D. So these Washington University physicians have written a book to address those problems.

In "Demystifying Psychiatry," Zorumski and Rubin, who have more than 50 years of experience treating psychiatric patients and helping patient families, say some of the problems related to psychiatric illness and treatment result from a lack of understanding psychiatry and what psychiatrists can and can't do.

"This book comes from many conversations we've had with people in the community, and individuals in our own families, who not only misunderstand psychiatric illnesses but don't understand who psychiatrists are and how they fit into health-care delivery," says Zorumski, the Samuel B. Guze Professor and head of the Department of Psychiatry. "Part of the impetus behind writing this was to emphasize those things in ways a lay audience would understand."

Psychiatric disorders can contribute to substantial suffering, disability and death. And the costs related to medical care and lost productivity can be high. Although it's possible to diagnose and provide effective therapy for many disorders, misunderstanding psychiatric illnesses and treatments can lead to major disparities in the likelihood that an individual patient will receive necessary and potentially life-saving treatment.

"Psychiatric illnesses are the most disabling group of illnesses in the world today," says Rubin, professor of psychiatry. "I personally believe that not recognizing severe depression or not addressing severe alcoholism is tantamount to avoiding or ignoring advanced diabetes or severe hypertension. Part of the reason for this book is to increase awareness."

Unlike many popular books about psychiatric illness, "Demystifying Psychiatry" makes clear that "quick fixes" are rare in the field. In that way, the authors explain, psychiatry is similar to many other branches of medicine. Psychiatrists and psychiatric treatments help many patients feel better, but genuine cures are rare.

"Full cures are uncommon in much of medicine, including psychiatry," Rubin says. "Medications can help, but not as much as we're sometimes led to believe."

It is estimated that one of every three people will need mental health services at some point in life. The mental health field, the authors write, has been through many fads over the years, and to avoid treatments that may not help, it is important that patients become educated consumers. For example, the authors say that if a provider seems to be speaking in mystical or unrealistic terms, patients should be cautious and seek another opinion. The book includes an extensive bibliography to refer lay readers to other books and information.

Because of the stigma often associated with psychiatric illness, many who feel depressed or anxious, or who find they are having a hard time making it through the day without a drink, may resist seeing a psychiatrist.

Although some people are reluctant to see any doctor at all, those with common medical illnesses tend to show up eventually when they develop serious, physical symptoms that make it impossible for them to function. With psychiatric illness, however, patients, including those with serious psychiatric symptoms, often don't recognize anything is wrong, even when they no longer can function. Zorumski and Rubin hope the book helps those patients and their families recognize problems early, to learn how to seek psychiatric care and to become familiar with what treatments might help, keeping in mind that in many cases the therapy can take a while.

"It doesn't matter whether we're talking about major depression - a very common psychiatric illness - or high blood pressure or diabetes," says Zorumski. "Those illnesses don't get cured. They're managed over time. And that's one of the things we really want consumers, and those who have illnesses, to understand. The expectation that a pill or some other form of treatment is going to cure you is really inappropriate, just as it is inappropriate with high blood pressure and other common illnesses."