Does my psychiatrist know how to listen?
- powersprout
- 1 day ago
- 4 min read
Updated: 19 hours ago
Some people find psychiatric medications to be supportive during challenging times and/or life-saving on a daily basis. However, for those who seek prescription medications from providers, they may come away disappointed with the patient-physician interaction.
Objective: This discussion briefly outlines some of the historical underpinnings that have led to problematic provider interactions, and ends with ways that individuals can advocate for themselves to get the best care possible.
Psychiatry: A brief historical overview
Psychoanalytic-informed psychiatry, also known as dynamic psychiatry, was the dominant paradigm during the initial emergence of psychiatry in the early 19th century. This psychiatry required a lot of time between doctor and patient, with the doctor getting to deeply know the individual. In dynamic psychiatry, symptom presentation was not taken at face value, but held as manifestation of disturbance originating from a hidden or underlying internal conflict. Symptoms were symbols with historical intrapsychic context, rather than explicit, objective indicators of an illness. More simply, symptoms and treatment were not deduced by checking off a bunch of boxes.
Between the 1960s and 1980s, however, the financial success of dynamic psychiatry dramatically decreased. These socioeconomic forces, accompanied by cultural and political changes, inspired a swift revolution in the psychiatric conceptualization and treatment of mental illness (Horwitz et al., 2002.) In the 1970s, the psychiatric profession adopted a diagnostic model with categories and criteria to establish itself as a legitimate medical treatment of disease. Symptoms that were once signposts pointing towards historical, intrapsychic landscape became concretized as diagnostic criteria for mental illness.
Psychiatrist and psychoanalyst Dr. Elio Frattaroli distinguishes between a psychiatry that is framed by the diagnostic approach versus one guided by a more psychoanalytic (dynamic) frame. He writes, “In the Age of the Brain, psychiatric treatment has been reduced to an exclusively I–It relationship, in which patients are objectified, diagnosed as ‘cases,’ equated with their brains (and genes), and treated according to standards of statistical science” (p. 12).
When the American Psychological Association adopted a biology-based disease model approach to mental illness, symptoms were more naturally understood as treatable through medication—and pharmaceutical industries stood to benefit from this change, eventually leading to the current psychiatric pharmaceutical industry. Some of the clear benefits of this industrial change include: insurance coverage for medications (without a legitimized medical diagnosis no coverage), federal funding for companies to conduct extremely expensive medical trials so that the medications can undergo FDA safety and efficacy testing, and on it goes. While this system doesn’t have significant flaws, it’s not just churning out expensive snake oil.
With this biology-based disease model turn in psychiatry, the layers of human experience including culture, trauma, economics, political, spiritual, and familial dimensions are less likely to be taken into account. Some (not all) physicians may rush through questions checking off diagnostic boxes. For this reason, it is important that if an individual believes that their life experiences such as divorce, trauma, schooling may be contributing to depression or anxiety, it is a good idea to bring this up to the practitioner if they don’t ask.
Quality of care and advocating for your needs
One of the challenges some patients may face is not know if a new doctor will listen well or know the right questions to ask. Poor or inadequate listening can happen; the general medical field has undergone a decline in the time medical educators take to teach medical history taking with less emphasis on the clinical interview, (Faustinella & Jacobs, 2018).
Clinical interviewing or taking the time to listen may instead be seen as less cost effective then using tests or technology, (Fava et al., 2024). Although there is a prevailing awareness amongst doctors on the importance of listening during the clinical interview, very few medical educators have utilized research on listening and communication, (Meldrum & Apple, 2020).
Resources and tips on Advocating for psychiatric medical care
It is really important that people know how to advocate for themselves when seeking medicalized treatment, because this can help to increase positive treatment expectations. Research has shown that simply having better expectations really can improve treatment outcome, (Rief & Wilhelm, 2024).
Both power imbalance and thinking that it is not okay to challenge doctors are two factors that can make self-advocacy more difficult according to the research. Below are suggestions that can help people navigate perceived power imbalance and/or disagreement.
1. Don’t be afraid to come to your provider with notes.
2. Take down notes on your symptoms, questions, life situations that may be contributing to symptoms.
3. Think on if you have had a past negative experience with a provider. What would you have done differently?
4. Don’t be afraid to bring a trusted person with you if that would make it easier.
5. If you are feeling nervous, perhaps it is good to say this. After all, this is helpful information for assessment and it give you an opportunity to test out whether your practitioner responds in a comforting way.
6. Be firm about your needs.
Here is a podcast that talks about advocating for general mental health, specifically addressing issues that BIPOC youth can face.
