In my nearly thirty years in Psychiatry…

I started training at Vanderbilt in 1984, right after graduation from medical school-there have been major changes in how the field is viewed. I opened my practice in Franklin against the advice of my friends and mentors. It was common knowledge that no one would see a Psychiatrist in a small town but would choose the anonymity of going to Nashville. My shingle showed my specialty to be ‘Behavioral Medicine.’ Everyone knew that Psychiatrists were crazier than their patients. I’ve known some crazy Paychiatrists (and am making no claims for myself) but I’ve also known some really crazy surgeons and we don’t even need to talk about Proctologists. As it turns out, psychiatric patients are not crazy. They are a group, largely comprised of people who are motivated to control or eliminate their symptoms. And that’s a key point-psychiatric symptoms can often be eliminated. In medicine, much to my surprise, there are countless illnesses that can be controlled or managed (hypertension, diabetes, asthma, and so on).
In psychiatry we aim to eliminate depression, the most common problem that people come in with. Of course, we have our chronic illnesses, too. Anxiety, obsessive-compulsive disorder, and bipolar disorder come to mind. We also see the serious illnesses such as schizophrenia and dementia-these are like the cancer diagnoses in a general practitioners office. They get a lot of the recognition because they can be so dramatic but fortunately, they only afflict a few. Unfortunately, the news has been filled lately with the issue of mental illness in people who are randomly violent. There have been a number of mass shootings in the news that have captured our attention. Clearly there needs to be more work done on recognizing the potential perpetrators of violence but my concern is that we may see the public perception of psychiatry return to views held in the past.
In my career I have seen literally thousands of patients, including in jails and prisons and have never felt at risk. We may be reversing cause and effect. We choose to see Adam Lansa as mentally ill because there is no way to understand his actions in the Newtown Elementary School, so he must be crazy. If we stigmatize patients who seek help for their problems we will not move toward better recognition and treatment. When I evaluated murderers for the State, I did meet a few psychiatrically ill people but mostly I saw people who were criminals and /or mean. These were, no surprise, not the insightful and caring people who sit in my waiting room. It is my hope that, as a society, we can continue to mature and we can be proud of a person who makes a choice to see a psychiatrist and get some help.
John Cain, MD