PhD/PsyD Whiny Neuropsychology vs Medicine Question/Rant

[fellwynd2]

I apologize for the whiny rant to come. I’ve posted on here before about my inability to decide between psychology and medicine, and I think I’m finally getting to the point where I can’t keep putting the decision off. I’ve finally realized that my ability to not decide is partially based off of my OCD which I thought I’d taken care of through medication and therapy, but am now realizing is still very much a thing. Regardless, I don’t think I have time to do soul searching and treat my OCD before I make my decision, which brings me here. I find within a given month, week, or even day, I will flip flop between my decision to go into psychology or go into medicine, and that kind of thinking is not sustainable, leading me to become more stressed and depressed.

I think one of my big points of indecision is regarding the fact that I really enjoy biology and neuroscience, and I worry that going into psychology, even neuropsychology, won’t let me engage with that part of myself. My main interest in undergrad was neuroscience, and I would’ve majored in it in addition to/maybe instead of psychology if it were offered. The idea of studying social and personality psychology which don’t touch on biology (to my knowledge) at all just doesn’t appeal to me. In undergrad I avoided it like the plague, and all of my electives were stuff like psychopharmacology, neural development, and neurobiology when I could have taken abnormal and developmental if I would have chosen that. I understand that psychology is a science and behavior is an observable phenomena which can be analyzed objectively, but I want to understand the nuts and bolts of it, and I’m not sure I can do that as a clinical psychologist. I want to study neuroanatomy, I want to actually touch a brain, I want to understand how biology affects behavior, and I don’t know if doing clinical psychology will give that to me. I want to study how the brain relates to behavior, not just behavior alone and not just the cellular neuroscience alone. If I could be a clinical neuroscientist or something, using my knowledge of the brain to affect behavioral changes through TMS and CBT, that’s probably what I’d do. And as for neuropsychology I feel like neuropsychological assessment wouldn’t give me the “working with the brain” feeling that I really want, and I don’t think I’d enjoy doing assessments all day. I’ve tried to find literature on how neuropsychological assessments are directly related to brain activity (this test assesses functionality of the prefrontal cortex/the ventral object recognition pathway/something else like that) and I couldn’t- and I honestly feel like seeing how these assessments directly relate to brain activity could help.

So I guess that’s where I stand. I don’t want to be a psychiatrist and shovel meds in mouths the majority of the time (gross oversimplification I know), I don’t want to be a clinical neuropsychologist where I spend my time doing neuropsychological assessments where I feel like I don’t directly impact the brain of the person at all, and I don’t want to be a neurologist and work 60-80 hour weeks and let my relationships crumble to not really be involved in the process of treating behavioral issues. I want to treat behavior and brain function through behavioral neuroscience methods but I don’t know the right way to do that. I’m not even sure I know what methods I want to use quite honestly, I’m just so confused. I even thought about going and being a PA but I realized I like the idea of being an expert on the brain and behavior more than I like the idea of actually helping people, and now I just don’t know anything about my priorities. I’m sorry to be whining on this forum but I really don’t know where else to turn. I’m starting to think I myself need to get psychological help before I can make these decisions, but the idea of putting it off more just makes me spiral into existential issues. Again, I’m sorry to post cringe on this forum, but I just would really appreciate some guidance.

Thank you all.

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[tr]

It sounds like it would be difficult to align a psychology degree with your interests.
Do you want to treat patients or do you want to do research? (The motivation to 'be an expert' may not endear you to people seeking help. If you don't have a desire to help people, training to be a clinician might not be the right fit for you.)

If the former, MD and psychiatry residency.
If the latter, PhD in neuroscience and postdoctoral fellowship in area of interest.

If you want to treat patients with TMS and CBT you need to go to med school, do a psychiatry residency in which you get adequate exposure to evidence-based psychotherapeutic modalities, and spend some time post-residency to specialize in interventional psychiatry (i.e. neurostimulation).

 

[summerbabe]

I’m starting to think I myself need to get psychological help before I can make these decisions, but the idea of putting it off more just makes me spiral into existential issues.

Getting the right medical/psychological attention for OCD is going to help you in whatever you do, especially anything as grueling as attaining a PhD or MD so making that investment now, even if it ‘delays’ future decisions, will likely be worth it.

Based on what you wrote, it doesn’t sound like clinical psychology is the best fit. Even if your interest is neuropsych, you’ll still be spending a ton of time on developing psychotherapy competencies, receiving personality/non-cognitive assessment training, and virtually all core APA suggested coursework is not biologically-oriented.

 

[Ollie123]

If you are focused on becoming a clinician, I'd go Psychiatry/Neurology. Direct use of biological treatments is probably always going to be secondary in clinical psychology. That said, recognize a lot of these are still heavily experimental. A full-time TMS practice is not exactly commonplace.

If you want to go the research route as a primary professional activity, that is another matter and clinical psychology isn't a bad choice. You won't do much "wet" neuro (i.e. dissection) without other training, but honestly the chances of you touching a human brain as a practicing psychiatrist outside of a couple days in med school are also negligible. There are tons of psychologists studying the neural basis of behavior, psychopharmacology, etc. Actually, most of these people are not neuropsychologists but just general clinical psychologists specializing in related topics.

 

[Sanman]

You have told us a lot about what you do not want do. I am not sure exactly what it is that you want to do. Care to clarify your ideal day/job?

 

[AcronymAllergy]

I'd agree with what's been said above, and add that you might look into neuropsychiatry or behavioral neurology fellowships, and/or the MD/PhD route with a combination of psychiatry and neuroscience.

 

[jdawg2017]

I apologize for the whiny rant to come. I’ve posted on here before about my inability to decide between psychology and medicine, and I think I’m finally getting to the point where I can’t keep putting the decision off. I’ve finally realized that my ability to not decide is partially based off of my OCD which I thought I’d taken care of through medication and therapy, but am now realizing is still very much a thing. Regardless, I don’t think I have time to do soul searching and treat my OCD before I make my decision, which brings me here. I find within a given month, week, or even day, I will flip flop between my decision to go into psychology or go into medicine, and that kind of thinking is not sustainable, leading me to become more stressed and depressed.

I think one of my big points of indecision is regarding the fact that I really enjoy biology and neuroscience, and I worry that going into psychology, even neuropsychology, won’t let me engage with that part of myself. My main interest in undergrad was neuroscience, and I would’ve majored in it in addition to/maybe instead of psychology if it were offered. The idea of studying social and personality psychology which don’t touch on biology (to my knowledge) at all just doesn’t appeal to me. In undergrad I avoided it like the plague, and all of my electives were stuff like psychopharmacology, neural development, and neurobiology when I could have taken abnormal and developmental if I would have chosen that. I understand that psychology is a science and behavior is an observable phenomena which can be analyzed objectively, but I want to understand the nuts and bolts of it, and I’m not sure I can do that as a clinical psychologist. I want to study neuroanatomy, I want to actually touch a brain, I want to understand how biology affects behavior, and I don’t know if doing clinical psychology will give that to me. I want to study how the brain relates to behavior, not just behavior alone and not just the cellular neuroscience alone. If I could be a clinical neuroscientist or something, using my knowledge of the brain to affect behavioral changes through TMS and CBT, that’s probably what I’d do. And as for neuropsychology I feel like neuropsychological assessment wouldn’t give me the “working with the brain” feeling that I really want, and I don’t think I’d enjoy doing assessments all day. I’ve tried to find literature on how neuropsychological assessments are directly related to brain activity (this test assesses functionality of the prefrontal cortex/the ventral object recognition pathway/something else like that) and I couldn’t- and I honestly feel like seeing how these assessments directly relate to brain activity could help.

So I guess that’s where I stand. I don’t want to be a psychiatrist and shovel meds in mouths the majority of the time (gross oversimplification I know), I don’t want to be a clinical neuropsychologist where I spend my time doing neuropsychological assessments where I feel like I don’t directly impact the brain of the person at all, and I don’t want to be a neurologist and work 60-80 hour weeks and let my relationships crumble to not really be involved in the process of treating behavioral issues. I want to treat behavior and brain function through behavioral neuroscience methods but I don’t know the right way to do that. I’m not even sure I know what methods I want to use quite honestly, I’m just so confused. I even thought about going and being a PA but I realized I like the idea of being an expert on the brain and behavior more than I like the idea of actually helping people, and now I just don’t know anything about my priorities. I’m sorry to be whining on this forum but I really don’t know where else to turn. I’m starting to think I myself need to get psychological help before I can make these decisions, but the idea of putting it off more just makes me spiral into existential issues. Again, I’m sorry to post cringe on this forum, but I just would really appreciate some guidance.

Thank you all.

First of all, I agree with the other comments that getting medical and/or psychotherapeutic help for your OCD (if you are not already obtaining it) will be key in whatever path you take. All graduate/professional schools are grueling experiences that involve a lot of time and toleration of uncertainty, so it it good to build your treatment plan now. Also, to a degree, your views of all of those professions are heavily oversimplified, and regardless of your training path is will take up a significant amount of time/effort. I am a big advocate for figuring out your personal values and boundaries before graduate/professional school as a way to mitigate the impact on the profession negatively impacting your personal life.

I am toward the end of my training in neuropsychology. I agree with what has been said that if you have "literally zero" interest in directly helping people in your day-to-day life, a clinical psychology PhD (with a neuropsych focus) is likely not a good match. A good part of your training will focus on learning evidence-based techniques (e.g., cognitive behavioral therapy) and working directly with patients as a psychotherapy trainee. Neuropsychology is, by definition, the study of the relationship between the brain and behavior, and there is indeed a growing literature base about how certain neuropsychological tests tap certain areas of the brain. The original studies in the field were more lesion-based (e.g., patient H.M.), but more recently with the advent of neuroimaging techniques we can identify with spatial and/or temporal precision how brains are working during certain cognitive tasks. There is a *bit* of a disconnect between the cognitive science literature (which uses experimental tasks) and the actual neuropsychological literature, which usually uses tasks that have been psychometrically normed and studied behaviorally.

I would say it is possible, in theory, to become an academic researcher after getting your neuropsych training and never practice clinically again, but frankly I think the beauty of clinical psych/neuropsych is we are (or should be) trained to bridge the gap between basic science and implementation science. What is the point of being an expert on the brain/behavior if that expertise is not immediately directed at helping people? We need more neuropsychologists/psychologists who have expertise in treatment modalities and the brain/behavior who can help direct/execute studies that identify the causal mechanisms of change in things like TMS and CBT (what you mentioned as examples).

Beyond what has been said, there are other aspects to consider as well, such as the debt-income tradeoff of funded PhD programs vs. med school.

 

[SilverHearted]

I'm not going to get into all of the OCD issues you mentioned and your difficulty with making a choice because I think that other posters have well covered it.

But in regard to your career path, I want to second the mention of Behavioral Neurology. It might be the exact middle ground you're looking for.

 

[clausewitz2]

I'm not going to get into all of the OCD issues you mentioned and your difficulty with making a choice because I think that other posters have well covered it.

But in regard to your career path, I want to second the mention of Behavioral Neurology. It might be the exact middle ground you're looking for.

Caveat: if you don't really love dementia, jobs will be few and far between.

 

[WisNeuro]

Caveat: if you don't really love dementia, jobs will be few and far between.

And don't expect to be all that wealthy if you are doing solely clinical care with gero patients, on average.

 

[Sanman]

And don't expect to be all that wealthy if you are doing solely clinical care with gero patients, on average.

Dang, so that's where I went wrong.

 

[NeuroTrope]

Don't go MD. Neuropsych can earn way more.

 

[WisNeuro]

Dang, so that's where I went wrong.

Well, in the VA there is stability and a pension But your ceiling is pretty much capped unless you do legal work on the side.

 

[WisNeuro]

Don't go MD. Neuropsych can earn way more.

If you do legal work, or find a cash pay niche. If you're taking insurance and doing only clinical work, probably not. Though you will make it through grad school with no or minimal debt if you want.

 

[Sanman]

If you do legal work, or find a cash pay niche. If you're taking insurance and doing only clinical work, probably not. Though you will make it through grad school with no or minimal debt if you want.

Also depends on what kind of MD. Plenty of people who change course in med school.