A reader commented on one of my recent posts. I think many people who experience anxiety and/or depression feel similar, which is why I wanted to address it.
Reader: “I am a staunch follower of Objectivism [the philosophy of Ayn Rand] and have been for over 25 years. What you are talking about is a normally functioning brain. I know when something is not working right inside my brain and without the right medication there is nothing I can do about it. I have tried gradually decreasing the dosage several times after a long period of normalcy and it comes back and there is no amount of thinking I can do to change it. When the tool is broken it needs to be fixed. And, I know there is no way you can ever understand this without experiencing it. But, as a psychologist, you really need to listen to those who have experienced it. Depression/anxiety not only affects emotions. It causes other pains that shouldn’t be there. You can no more heal a malfunctioning brain by thinking than you can a malfunctioning thyroid. A general physician should know when to send a patient to a heart specialist. A psychologist should know when to send a patient to a psychiatrist. I am damn lucky mine did, or I wouldn’t be here today. Functioning normally, I might add.”
Dr. Orma: I do listen to my clients—that’s part of my job, and the only way I can understand what they’re experiencing emotionally, cognitively, behaviorally, and physically. Assessment is the first thing I, and most psychologists, do in the first sessions. However, in my view, a psychologist is not supposed to just listen to his or her clients (although some mainly just do this), but after listening and gathering the client’s report and history, the therapist should use his or her professional judgment as to what is contributing to the client’s problem(s). A psychologist shouldn’t just take on faith everything his or her client tells him. What clients report is one important part of the picture, but depending on the issue, more information may be needed. The type of information will depend on the type of problem the client is reporting. Assessment is always a work in progress, and things can change over time as the therapist gains more knowledge, and the client gains a deeper understanding of the main issues involved. This is what a therapist’s main job is—to provide professional guidance, knowledge, support, skills, in addition to active listening and understanding.
You’re correct that I may never understand firsthand what it feels like to have certain ailments. But, does this preclude me, or any other therapist, from accurately diagnosing and effectively treating these issues? Are therapists required to have experienced everything their clients have to be able to treat them? Does a therapist, for example, have to have experienced psychosis to treat schizophrenia, or have been phobic to treat a fear of flying? In my experience, this is not the case. Most therapists treat clients with issues they’ve never personally experienced (such as an eating disorder, substance abuse, etc.). Maybe this experience would help in some cases, maybe not. But I don’t think it’s required to be an effective and understanding therapist.
I don’t know your history or any facts about your situation, so I can’t comment on that. I can see where you might infer from my article that I am anti-medication or that I never refer to a psychiatrist. My point was to emphasize that even many cognitive therapists, who hold the view that thoughts/beliefs are the cause of emotions, still maintain there’s a biological component to psychological problems (a view I don’t hold), and thus will refer clients for medication because of this. My view is that, in some situations, medication is certainly warranted and can be helpful, such as with psychosis, severe depression, suicidality, extreme anxiety/panic, and others. In these cases, medication can ease the symptoms and discomfort so the person can function better and address the problem more effectively. It’s the personal choice of the client whether to take medication or not. If a client wants to be referred to a psychiatrist, I certainly honor that. Ultimately, it’s their choice, and ideally they’ll decide this thoughtfully after gathering all the facts about medication (side-effects, effectiveness, cost, etc.).
However, if there’s some suspicion (by me or the client) that the anxiety or depression is coming from a brain problem (as you say yours is), then I would refer him or her to an internist or specialist (such as a neurologist), not a psychiatrist. A psychiatrist will do nothing to examine your brain. Most don’t perform a medical exam or take blood tests, and certainly don’t perform brain scans. Psychiatrists use the same diagnosis methods as psychologists (usually a clinical interview) and use the same reference for diagnosis (the DSM-IV). In fact, it’s psychologists that are actually trained to be specialists in psychological assessment, not psychiatrists. Most psychiatrists (although not all) view psychological problems as mainly biological, and thus, will prescribe medication. Some will also do psychotherapy. A neurologist, on the other hand, will do specific tests on your brain, such as an MRI or CAT Scan. Maybe you’ve had these done and they’ve found an organic problem, such as a tumor or a lesion that would explain your anxiety and depression. But, psychotropic medication is not used to treat organic problems like these—procedures like surgery, radiation, or chemotherapy is.
The article will conclude in Part 2
Have a question you’d like Dr. Orma to answer in his blog? Please email him.
San Francisco & Marin Therapist
Dr. Steve Orma is a cognitive therapist in San Francisco and Marin providing individual therapy for anxiety, depression, stress, relationships, work/school, and other life challenges. To schedule a complimentary phone consultation, please contact him: