For a profession devoted to dialogue and understanding, psychiatry is awfully misunderstood. You know the familiar stereotype: the long couch, the dim lighting and the soothing voice asking, "And how did that make you feel?" But the reality is much more complicated, and in their new book Shrink Rap, Drs. Dinah Miller, Annette Hanson and Steven Roy Daviss describe what psychiatrists really do every day.
Daviss is a hospital-based psychiatrist. Early in the book, he describes "Oscar," a fictional patient he uses to explain facets of the psychiatric process. Oscar is going through a divorce, Daviss tells NPR's Neal Conan, and has been brought to the emergency room by police officers who charged him with a DWI. When Oscar told the police he wanted to kill himself, they brought him in, against his will.
Co-author Dr. Dinah Miller works in private practice in Baltimore, Md. She describes another fictional patient, "Melissa" — a pediatrician with "classic symptoms of major depression," says Miller. "She stops doing the things she usually does, her sleep is disturbed, her appetite is disturbed, sometimes while she's seeing patients, she leaves the room to cry." She's a doctor, and the child of someone with depression, so Melissa knows she needs to get help.
Through the stories of Oscar and Melissa, Daviss and Miller explain the different ways patients get help. Melissa seeks out a psychiatrist for therapy and receives medication. Oscar, who was admitted against his will, goes through the prison system of care. When he's discharged, Miller explains, he looks at the various options available to him on the outside: a community mental health center, an out-of-network psychiatrist and an in-network psychiatrist. "We use them to exemplify the different aspects of what we do," she says.
In the hospital, Daviss sees patients in the psychiatric unit, in the emergency room and on medical floors. "I would say the lion's share of patients who come in to be admitted to a psychiatric unit are coming in from the emergency room — like Oscar did," he says. At his hospital, he says 10-15 percent of those admittals are involuntary, which he thinks is typical for the state of Maryland.
One of the challenges in modern medicine is the coordination of care. A patient may be seeing multiple specialists — say, a cardiologist, a psychiatrist and a dermatologist. "The medications that are used can interact," says Daviss, so it's critical that the doctors communicate well to best serve the patient.
Psychiatrists and other doctors also have ethical constraints that can make it tricky to treat their patients. Clinically, it's important for them to share stories with their colleagues, to confer and share expertise at conferences and in journals. But they have to protect their patients' anonymity, too. Miller says they have ways of obscuring patients' identities, but are especially "tormented ... by this question of how to write about patients."
"One day I picked up The New York Times," she remembers, and thought an article a colleague wrote about a patient compromised confidentiality. That's why she and her co-authors decided to use fictional patients in their book. It allowed them to walk Oscar and Melissa through the process of seeking help without worrying about revealing specifics of their cases. Though the scenarios were true-to-life, the patients were comfortably fictional.
As for the real world, when people ask Daviss casually — that is, not in the office — if he's analyzing them, he's always ready with a glib response: "Only if you're going to pay me."