Mind, Body and Spirit - Integrative Medicine + Psychiatry or Career in Psychology?

[rr-ferreira]

Hi everyone!

I am from Brazil. I've been having a hard time to decide whether I should become a psychologist or a psychiatrist. I know that in order to practice medicine in the USA and other places abroad one has to pass through a different process, when compared to the one here in Brazil, where you finish high school being able to do an university entrance exam like SAT to study medicine directly as a graduation (6 years), with the first 2 years being about "the basics", something like the "pre-med" and later, after the 6 years,the residency programs \ specializations take place. Nowadays, I study for those exams to get into a medical school.

I've read plenty of threads from this and other websites about "psychology vs psychiatry", and some other articles, and I would like to share what I've seen this far, considering my personal interests.

I love to read about the human mind and behavior. When I read self-help books, about real stories, about memorization, setting goals, about developing specific qualities such as charisma, discipline, I always wonder how could I help a future patient of mine to solve his or her own struggles. I've been meditating for 2 years and have realized how much it is important to dedicate some time to ourselves consistently. I am so much more focused... It has positively affected the way that I cope with difficult situations, stress, negativity, especially anxiety. It's a practice that I intend to keep during medical school(sleeping 5 hours a day followed by 1 hour of meditation), which has enabled me to sleep better, start the day fresh. So, I've always liked to get to know about different aspects of the human mind, and also have a curiosity to integrate that knowledge with a medical background, that means integrating mind-body-spirit. I've been thinking about creating hypnosis and guided meditation recording in the future as an extracurricular activity.

What I've seen this far is that with the development of psychopharmacology, in the 20th century (correct me if I am wrong) there has been a drop in the amount of psychiatrists that are interested in doing therapy, considering that insurance companies have been limiting the amount of time that these professionals spend with their patients, in public community health clinics in general, making them restrict their jobs to prescribing medications in appointments lasting 15-20 minutes, and sending their patients to psychologists, social workers, to do therapy. There are some psychiatrists that would like to invest in therapy, but wonder if it's reasonable, considering the reasons before, the idea of limiting the amount of patients they see (making less money). But I've also seen that, in private practice, the doctor has more flexibility to determine how much time he\she wants to dedicate to do therapy, even if it means making a lower income than those that only prescribe medications.

I don't mind studying other things beyond the human mind... I think that it is interesting to do it and gives me other ways to help people. But I want to commit my job to self-exploration and self-development of patients, with a medical background and a “therapeutic background”... I don’t mind about how long it takes. I am just concerned if will be able to reach my goals.

I have an idea of what I might do as a psychiatrist: I want to specialize in cognitive behavior therapy and later to become an integrative medicine doctor, focusing on the patient as a whole, enabling me to be relationship-centered in my approach to medical care. I am also considering later to become a certified personal trainer. I want to make a difference in other's peoples lives, using medications only when necessary to treat patients, turning to them as a LAST RESORT. I wanna be able to provide exercise related education, motivational support, nutritional counseling, self-care strategies, life coaching.


Integrative medicine seems to be one of the best ways to go, despite the fact that it is a recent area of study, not very know here in Brazil. I am definitely considering traveling to the USA in the future, where I've found out with my researches to be one of the best places to study about it, specially in Arizona (https://integrativemedicine.arizona.edu/)

It is rare to see a psychiatrist who dedicates a fair amount of time doing therapy well. I wonder how good he is to do it, considering that most residency programs don't promote a deep study of psychotherapy. However, I've understood that it's up to him to have the urge to study that more profoundly later, if he is willing to take that time... Furthermore, I've seen that private practice doctors usually have more flexibility, being able to determine how much more therapy they want to do...

What I ask you is: is it worth it to "go against the flow" to become this kind of doctor, this idealized mental health professional (integrative medicine doctor, CBT, psychiatrist) that cares about the whole person, including all aspects of lifestyle, or should I just spare me these concerns :
1- The huge amount of time to study medical related subjects
2- Being or not being able to make appropriate use of therapies and to invest in other interests
- and become a psychologist once and for all, whose focus is primarily on the mind and human behavior?
On the other hand, these interests (human behavior) might help me to become a better, different doctor, specifically an aspiring psychiatrist, considering that I know that I can study hard and pass succeed in medical school. I know that a psychiatrist makes more money than a psychologist, but I just wanna be very specific about being able to do what I want to do.
How realist and promising are my ideas as a doctor, in the future of medicine, which
nowadays seems to be leaning towards more frequent use of medications in psych?

How flexible can a psychiatrist's job be after medical school?

---

Members don't see this ad.

 

[deleted343839]

I wanna be able to provide exercise related education, motivational support, nutritional counseling, self-care strategies, life coaching.

You don't have to be a psychiatrist or a psychologist to do any of these things. This is basically what health coaches do. In fact, the Arizona program you mentioned trains health coaches.

Integrative medicine is the new term for what used to be called complementary and alternative medicine (CAM). Integrative medicine combines conventional medicine with CAM interventions. In practice, it is mainstream medicine with an additional income stream. There is really not a lot of rigorous evidence to support most CAM interventions, unless you consider things like regular exercise under the CAM umbrella (I do not). In general, the integrative medicine literature is not known for its rigor or quality.

Both psychiatry and psychology are oriented toward interventions that have empirical evidence to support their use in specific populations. Your license doesn't preclude offering non-empirically supported treatments, but your ethics should at least put the brakes on. However, some interventions, like exercise and mindfulness training, have been tested more rigorously for people with anxiety and mood disorders, usually as an adjunct to other behavioral treatments.

I think psychology or psychiatry could fit with your overall goals, but if you think that practicing medicine will be a necessity for your future practice, then psychiatry is really the only way to go. There are pros and cons to both paths. Earning potential is higher in psychiatry, even with lower patient volume.

 

[WisNeuro]

Do you know what do they call alternative medicine that works? Medicine.

 

[smalltownpsych]

Hey, I take the whole person into account. Why wouldn't I? Relationships, cognitive processes, emotions, behaviors (exercise, work, play, addictions, compulsions), diet, spiritual and religious practices, social and cultural background, occupation, education, biology, genetics, and maybe even a few more factors. For some of these, it is my primary focus, for others I work with patient on overcoming their resistance to doing what is healthy for them and avoiding what is not.

Also, I am very anti-medications in some ways as I think they are misunderstood and misused by many and are over prescribed by many providers. Nevertheless, for some diagnoses, medications are the first choice, not the last choice. A psychologist recognizes their own biases and how they might shade their judgement and takes steps to mitigate them.

 

[rr-ferreira]

Hey, I take the whole person into account. Why wouldn't I? Relationships, cognitive processes, emotions, behaviors (exercise, work, play, addictions, compulsions), diet, spiritual and religious practices, social and cultural background, occupation, education, biology, genetics, and maybe even a few more factors. For some of these, it is my primary focus, for others I work with patient on overcoming their resistance to doing what is healthy for them and avoiding what is not.

Also, I am very anti-medications in some ways as I think they are misunderstood and misused by many and are over prescribed by many providers. Nevertheless, for some diagnoses, medications are the first choice, not the last choice. A psychologist recognizes their own biases and how they might shade their judgement and takes steps to mitigate them.

Yeah, I know that there are some exceptions, that there are mental health professionals who are interested in this kind of approach. However, I always wondered about how feasible it would be to be this kind of "do-it-all" provider as a psychiatrist, because of the financial pressure by insurance companies to limit your time and stuff, I mean, to invest on different approaches to help a patient, also considering that psych doctors perform psychotherapies on a very limited basis and on occasional consults... I am sure that psychologists have more time to do it. However, I already understood that with private practice, doctors have more flexibility and stuff. When I tell people that I wanna be this "peculiar" psychiatrist, they think that it is just silly to have already "determined" a specialty. I mean, I am interested about sports medicine. There is also nutrology here in Brazil. I haven't seen lots of information about the latter abroad. Anyway... I am interested to study about them, but cannot imagine myself in a career as I do with psychiatry.

By the way, I am 18 years old. I have always succeeded in high school, in all the subjects, but my higher grades where in social sciences, although my chemistry, physics and biology were great as well. I did lots of sports (basketball, handball, swimming) and participated briefly in a theater program, which made me get interested in the human behavior and read books about it and think about psychology and later, psychiatry. I am passionate about the human behavior, but wonder what will I be missing as a doctor, once I see that I have a potential in both areas...

 

[lymphocyte]

What I ask you is: is it worth it to "go against the flow" to become this kind of doctor, this idealized mental health professional (integrative medicine doctor, CBT, psychiatrist) that cares about the whole person, including all aspects of lifestyle, or should I just spare me these concerns

On a practical note, it's probably not a good idea to become an "idealised" anything. Reality is often very different from one's idealisation of reality. You've clearly done a lot of reading, but how much time have you actually spent observing a psychologist or a psychiatrist practice? Maybe that's the way forward, to get a better idea of the practical limitations of either field.

Most psychiatrists I've worked with take very seriously things like lifestyle modification and motivational support. Even the Mass Gen Residency Handbook of Psychiatry (a super-condensed pocket book intended for psychiatry residents doing ward consultations) devotes over a dozen pages to psychotherapy and behavioural interventions. But those techniques have limited roles in treating relatively common psychopathology like psychosis, bipolar mania, substance intoxication, or delirium. By the same token, medications aren't always indicated for psychopathology, and it might be better to refer to psychologists who often have more experience providing non-pharmaceutical interventions. (Though lots of psychiatrists have the training and inclination to provide psychodynamic therapy.)

But any licensed physician can tailor their practice however they wish, as long they're meeting their duty of care. Sometimes that duty means using medication as a first resort as @smalltownpsych points out. You can "integrate" mind and body all you want, but sometimes patients need, for example, acute sedation for the safety of themselves and others. And as a psychiatrist or a psychologist, you're often faced with the prospect of depriving somebody of their liberty to save their life, and no amount of "life coaching" will fix things in that acute crisis.

I have to say that it's odd you're saying "I don’t mind about how long it takes" and then wondering in bolded letters about the "the huge amount of time to study medical related subjects." If medicine interests you, pursue a career in psychiatry. If psychology interests you, pursue a career in psychology. There's certainly overlap and maybe spending time in both fields with both will make the decision easier.

Edit: Nevermind. Just saw that you're in 18 living in Brazil wondering about PP in the US. That's at least 12 years down the line. Go shadow!

 

[nitemagi]

Is it worth it?

Based on what metric?

 

[rr-ferreira]

You don't have to be a psychiatrist or a psychologist to do any of these things. This is basically what health coaches do. In fact, the Arizona program you mentioned trains health coaches.

Integrative medicine is the new term for what used to be called complementary and alternative medicine (CAM). Integrative medicine combines conventional medicine with CAM interventions. In practice, it is mainstream medicine with an additional income stream. There is really not a lot of rigorous evidence to support most CAM interventions, unless you consider things like regular exercise under the CAM umbrella (I do not). In general, the integrative medicine literature is not known for its rigor or quality.

Both psychiatry and psychology are oriented toward interventions that have empirical evidence to support their use in specific populations. Your license doesn't preclude offering non-empirically supported treatments, but your ethics should at least put the brakes on. However, some interventions, like exercise and mindfulness training, have been tested more rigorously for people with anxiety and mood disorders, usually as an adjunct to other behavioral treatments.

I think psychology or psychiatry could fit with your overall goals, but if you think that practicing medicine will be a necessity for your future practice, then psychiatry is really the only way to go. There are pros and cons to both paths. Earning potential is higher in psychiatry, even with lower patient volume.

Yeah, I saw the health coaching programs in there. I definitely have potential in both areas. Although as a medical student my lifestyle can be pretty crappy for a while, I've seen that the after the psychiatrist training it is very good compared to other physicians. Moreover, earning potential is higher in psychiatry when compared to psychology. It is a much safer career choice, when we look at the long-term picture. Many people have been stating that they as a doctor, one will be doling out meds only, that if one wants to become a psychiatrist and practice therapy, he has to be prepared to see only wealthy patients, because they usually charge more.

 

[rr-ferreira]

Is it worth it?

Based on what metric?

I understand that a psychiatric patient will not exist in a bubble. They will mostly present other problems, like diabetes, hypertension, etc, and a medical background in these situations come in handy. It is challenging and interesting somehow. I always imagined that investing on other approaches to treat stress, depression, in other words, in slightly different fields, such as those health coaching programs, I could raise my income, providing other services, reaping the benefits of different kinds of patient care. Psychiatrists don't work as many hours as other docs do. They have a lighter schedule, more flexibility, high demanding job, working less hours a week. I don't believe that the process of training finishes when residency ends, so I wonder about "upping the ante", but I fear it's limitations. That's exactly where I think about considering to become a psychologist, thinking that it's better to choose something that I am dead-set passionate about: human behavior , that "integrative approach" that I talked about before with therapy and spare me these concerns of not being able to develop than in a doctor's practice which is generally restricted to med management appointments.

So I wonder how much competent would I be to do those things. As a psychiatrist, I will have to be highly motivated to get additional training, but will the reality corresponds to my expectations? I don't want to only do therapy, just would like to balance it with med managements, creating more variety. That's what I mean when I ask if it will it be worth it, considering that many people think that to be a doctor you have to be in love with the sciences. I am in love with dealing with people and improving different aspects of them, by a biological level and a psychological level.


Medical school is hard but I think can be bearable for me. I may study things that are unrelated to psychiatry but it will be for a better long-term cause. I don't think that it is necessary to be interested in plenty of specialties. I think that it's great to have a goal that I am passionate about, but I would like to know if\how much am "idealizing" here, if I'm falling into a trap. I know that any decision requires risks, but I want to be the most down-to-earth as possible.

I have found a woman that does mostly the things that I like: http://www.ozkarahanmd.com/
https://psychiatrists.psychologytod...arahan_MD,NASMCPT,FNS_New+York_New+York_78480

She has been selected as a Top Pscyhiatrist in NYC and also entered into the "Leading Physicians of the World" publication. She's specialized in cognitive therapy, anxiety, depression, relationship issues and carries some other interesting things in her curriculum like some credentials: National Academy of Sports Medicine/Certified Personal Trainer and National Academy of Sports Medicine/Fitness Nutrition Specialist
I e-mailed her, to get to know more about her job, but I don't think that she will answer, lol. It would really, really help.

 

[rr-ferreira]

On a practical note, it's probably not a good idea to become an "idealised" anything. Reality is often very different from one's idealisation of reality. You've clearly done a lot of reading, but how much time have you actually spent observing a psychologist or a psychiatrist practice? Maybe that's the way forward, to get a better idea of the practical limitations of either field.

Most psychiatrists I've worked with take very seriously things like lifestyle modification and motivational support. Even the Mass Gen Residency Handbook of Psychiatry (a super-condensed pocket book intended for psychiatry residents doing ward consultations) devotes over a dozen pages to psychotherapy and behavioural interventions. But those techniques have limited roles in treating relatively common psychopathology like psychosis, bipolar mania, substance intoxication, or delirium. By the same token, medications aren't always indicated for psychopathology, and it might be better to refer to psychologists who often have more experience providing non-pharmaceutical interventions. (Though lots of psychiatrists have the training and inclination to provide psychodynamic therapy.)

But any licensed physician can tailor their practice however they wish, as long they're meeting their duty of care. Sometimes that duty means using medication as a first resort as @smalltownpsych points out. You can "integrate" mind and body all you want, but sometimes patients need, for example, acute sedation for the safety of themselves and others. And as a psychiatrist or a psychologist, you're often faced with the prospect of depriving somebody of their liberty to save their life, and no amount of "life coaching" will fix things in that acute crisis.

I have to say that it's odd you're saying "I don’t mind about how long it takes" and then wondering in bolded letters about the "the huge amount of time to study medical related subjects." If medicine interests you, pursue a career in psychiatry. If psychology interests you, pursue a career in psychology. There's certainly overlap and maybe spending time in both fields with both will make the decision easier.

Edit: Nevermind. Just saw that you're in 18 living in Brazil wondering about PP in the US. That's at least 12 years down the line. Go shadow!

Lol Oh man I laughed. I took the time to look about it, because there isn't a website such as this in here, that provides so much information about people that have passed through this process of doubt, or that are already studying at a medical or psychology school, etc.

I can tell you that I've already gone to a psychologist and a psychoanalyst before. I spent more time with a psychologist. I liked him more than the psychoanalyst. The approaches were so different! The analyst was colder than him, was sitting further way from me compared to him, taking notes, and for that and some other reasons, I couldn't establish a great connection with her. I couldn't express the whole scope of my personal problem with her, even though we spent almost one year together. However, with the psychologist, on the very FIRST DAY, I could spit it all out. It was amazing. We talked about my career choices, but at that time I didn't have looked deep about what doctors and psychologists do, the differences between their lifestyles, graduation, as I have been doing right now. I told him that I wanted to be exactly like him. He even suggested some books about his field to read, and I liked it a lot.

He told me that I have lots of potential as a psychologist, in the mental health field. I told him about psychiatry at the time, but didn't have many opportunity to talk about it, because I had left later, considering that he succeeded in helping me to solve my personal problem that lead me to him at the beginning. I was 100% focused on medical school. We talked about so many things, talked about body language, about what I was learning about human behavior. He was a really good friend to me, and insisted that I saw him that way as a psychologist, so I felt more comfortable with him than with that psychoanalyst. I spent 2 years going to him. At that time I was in high school.

Nowadays, I am studying at a preparatory course for university entrance exams like SAT to get into a medical school. As I told before, the process here is different, you can do it as a graduation right after high school, but I didn't pass, so I went looking for a preparatory course. So it's not uncommon for people on my age to be wondering about it, although I graduated high school when I was 16 years old. It consists of 3 years in here. In addition to that, you can choose to go immediately to any school, once you take those exams, without needing to pass through a college like in the USA that consists of 4 years of studying.

I admit that I've never shadowed a psychiatrist or made an appointment with him. I talked with some psychiatrists in here, they said that to be interested in any kind of therapy as a doctor, one has to go through an "analytic formation" that usually takes 5 years. So I've been trying to put the pieces together, will consider to shadow one and hopefully will come to a decision soon.

 

[nitemagi]

Leading physicians of the world is a scam. It's a paid vanity title (you pay to get your name in a listing) -- has no relation to actual ability, competency, clout, or anything else.